Genitourinary Flashcards
List 6 differentials for urinary incontinence in a young, spayed bitch
Hormonal-responsive (post-spay) incontinence
Ectopic ureters
Lower or Upper motor neuron disorders or reflex dyssynergia
Urge Incontinence (inflammation or infection)
Anatomic outflow obstruction (paradoxic incontinence)
Behavioral incontinence (submissiveness)
What’s the most common type and location of ectopic ureters? What percentage of patients are affect by bilateral disease?
The most common location for termination of ectopic ureters is in the urethra, although termination in the uterus and vagina can occur. Ectopic ureters are classified as intramural (the ureter enters the bladder wall at a normal anatomic position, but a portion of the ureter extends submucosally within the bladder wall before it enters the urethral lumen; Fig. 24.14A) or extramural (the ureter bypasses the bladder to enter the urethral lumen; Fig. 24.14B). Bilateral ectopic ureters occur in more than one-third of dogs (some reports have suggested more than 90%). Other abnormalities noted in some dogs include double ureteral openings (i.e., where the ureter opens in the bladder plus more distally; Fig. 24.14C) and ureteral troughs (Fig. 24.14D). Ureteral ectopia is much less common in cats.
What are the diagnostic options for the diagnosis of ectopic ureters? Which one is the most reliable diagnostic option?
Excretory urogram (based on radiographs), ultrasonography, cystoscopy and CT excretory urography.
CT excretory urography is the most sensitive method for diagnosis of ectopic ureters, and if available, should be considered the imaging modality of choice
What procedures are most commonly used for the treatment of intramural and extramural ectopic ureters?
Neoureterostomy (for intramural)
Ureteroneocystostomy (for extramural)
What is the overall prognosis, in percentage of patients that remain fully continent, after surgically corrected ectopic ureter?
Past reports suggest that as few as 30% of patients are fully continent postoperatively; however, 72% of male and female dogs with surgically-corrected ectopic ureters were continent in a 2012 study.
Many dogs with ectopic ureters have functional abnormalities of the urinary bladder or urethra. Obtaining urethral pressure measurements before surgery and after initiating diethylstilbestrol, estriol, or phenylpropanolamine therapy (see p. 666) may help predict the likelihood of continence after surgery. Siberian huskies are particularly prone to postoperative incontinence because of a high incidence of concurrent urethral sphincter incompetence. These dogs may respond to diethylstilbestrol, estriol, alpha-adrenergic agonists, or imipramine. If bladder hypoplasia is present, incontinence may continue until the bladder enlarges and properly functions as a reservoir. Dogs with ureteral troughs may have a poorer prognosis than dogs with nondistended intramural ectopic ureters. Failure to resect a ureterocele may result in continued incontinence and UTI.
Minimally invasive option for the treatment of intramural ectopic ureter’s
Cystoscopically-guided laser ablation
What are the functions of the pelvic nerve
Provides parasympathetic motor innervation to the bladder detrusor muscle (General visceral efferent) and Sensory innervation (General visceral afferent)
“The preganglionic neurons are located in the sacral spinal cord segments. Preganglionic axons synapse with ganglionic neurons at the pelvic ganglia and within the wall of the bladder.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What are the functions of the pudendal nerves and where do they originate?
“The pudendal nerves supply somatic innervation (motor [general somatic efferent] and sensory [general somatic afferent]) to the external urethral sphincter, perineal musculature, and anal sphincter and skin of the perineum (sensory). The neurons that give rise to the pudendal nerve are derived from the sacral spinal cord segments.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Describe the origin, synapses and functions of the hypogastric nerve
“The hypogastric nerve supplies sympathetic innervation to the internal urethral sphincter, the pelvic (parasympathetic) ganglia, and the detrusor muscle. The preganglionic neurons are located in L1 through L4 spinal cord segments. Preganglionic axons course through splanchnic nerves to synapse with their ganglionic neurons in the pelvic plexus. Postganglionic sympathetic axons course in the hypogastric nerve. Sympathetic input to the pelvic ganglia inhibits the ganglionic parasympathetic neurons during urine storage. The hypogastric nerve also contains sensory fibers (general visceral afferent) from the bladder wall and is involved in bladder nociception. Descending motor information includes inhibitory and excitatory upper motor neuron input to the detrusor muscle and urethral sphincters.61”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Describe the mechanism of urine storage and the development of UMN bladder as a result of T3-L3 myelopathy
“Normal urine storage and voiding are accomplished by both reflexive and conscious input.61 Urine storage is accomplished by beta-mediated detrusor muscle relaxation, alpha-mediated internal urethral sphincter tone, and cholinergic (nicotinic)-mediated external urethral tone. To empty the urinary bladder, adrenergic input to the bladder is decreased, allowing increased detrusor muscle activation and decreased internal urethral sphincter tone. Cholinergic stimulation via the pelvic (parasympathetic) and pudendal nerves (skeletal innervation) results in detrusor muscle contraction and external urethral sphincter relaxation, respectively.
With damage to the upper motor neurons affecting the urinary bladder, the sacral spinal cord segments supplying the pelvic and pudendal nerves remain intact. The transmission of ascending and descending information to and from the brain is decreased or lost. The result is an upper motor neuron bladder in which there is urinary incontinence with increased detrusor muscle and external urethral sphincter tone, presenting as a large, firm bladder that is difficult to express and may overflow as intraluminal pressure overwhelms the urethral sphincters”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What class of drugs is commonly used for treatment of upper motor neuron bladder? Give two examples.
“Pharmacologic intervention targets relaxation of the internal urethral sphincter and may include alpha-adrenergic antagonists, such as phenoxybenzamine (0.25 to 0.5 mg/kg q12h to q24h, PO) or prazosin (1 mg/15 kg q8h to q24h, PO). Prazosin is advantageous in that it has a more rapid onset and is more specific for alpha-1 receptors.6”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What class of drug is typically used for therapy of lower motor neuron bladder in dogs? Give one example
“ In dogs with bladder atony, a parasympathomimetic such as bethanechol (2.5 to 25 mg total dose q8h, PO) may be used in addition to an alpha-1-adrenergic antagonist after therapeutic levels of the alpha-1-adrenergic antagonist have been reached. Bethanechol may cause vomiting, diarrhea, excessive salivation, and anorexia”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
List 11 risk factors for the development of urinary tract infections in patients with spinal disease
Gender
Incomplete avoiding
Elevated intravesical pressure
Prior dexamethasone administration
Mucosal damage associated with catheter insertion
Catheter contamination
Proximity of the retry to sources of virulent microorganisms
Retrograde flow of urine from the collection system to the bladder
Normal to alkaline urine pH
Low urine osmolality
Pre-existing conditions (cystic calculi, hyperadrenocorticism, diabetes mellitus, immune compromise)
Explain the phenomenon of “spinal walking”
“Spinal walking involves the use of pelvic limb reflexes, trunk “muscles, and any remaining upper motor neurons to generate a gait as opposed to conscious voluntary walking. Most of these dogs will not develop urinary and fecal continence.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright. ”
Ammonium urate calculi - Most common breed and disease process to lead to this type of calculus? What is the bio chemical reason for this breeds predisposition to this type of calculus?
Ammonium urate stones are most common in Dalmatians and in dogs with congenital portosystemic vascular shunts.
Dalmatians do not convert most of their metabolic urate to allantoin and thus excrete the bulk of nucleic acid metabolites as relatively insoluble urate. The net result is that only 30%–40% of urate is converted to allantoin in Dalmatians compared with ~90% in other breeds.
What are the electrolyte and cardiac consequences of prolonged urethral blockage? What EKG abnormalities may be observed?
Prolonged urethral blockage leads to severe hyperkalemia, metabolic acidosis and post-renal azotemia. Hyperkalemia may lead to life-threatening cardiac arrhythmias due to its effect on cardiac electrical conductivity. These may begin as bradycardia and spiked T-waves, progressing to depressed R-waves, prolonged QRS and PR intervals and ST segment depression.
In what species are circumcaval ureters occasionally observed and possibly responsible for benign ureteral obstruction?
Cats
Patients undergoing renal biopsy should receive IV fluids before during or shortly after the procedure. What’s the rationale for this practice?
“Administering fluids before, during, and shortly after biopsy to initiate and maintain a mild diuresis may reduce formation of blood clots in the renal pelvis, which could cause obstruction and further loss of GFR. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
When obtaining renal biopsies, what is the minimum number and size of samples to be submitted? What tests should you request, how should the samples be stored and to which laboratory should you submit the sample?
“at least two samples larger than 10 mm or three samples smaller than 10 mm are recommended.
“Cut the sample into three sections; place one in 10% neutral buffered formalin solution for light microscopy, one in glutaraldehyde for electron microscopy, and freeze one for immunofluorescence.”
Request light microscopy, immunofluorescence, and electron microscopy
International Veterinary Renal Pathology Service, a joint collaboration of Texas A&M University and The Ohio State University.”
“The minimum numbers of glomeruli considered necessary for accurate diagnosis of glomerular disease are as follows: 5 to 10 for light microscopy, 1 to 2 for electron microscopy, and 3 to 5 for immunofluorescence. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
In cases of generalized diffuse kidney disease, which kidney is typically preferred for biopsy? Why?
The right kidney is technically easier (less mobile)
Describe the technique for nephrectomy with emphasis on the necessary precautions pertaining to the placement of vascular ligatures
“Grasp the peritoneum over the kidney and incise it. Using a combination of blunt and sharp dissection, free the kidney from its sublumbar attachments. Elevate the kidney and retract it medially to locate the renal artery and vein on the dorsal surface of the renal hilus (Fig. 24.3). Identify all branches of the renal artery. Double ligate the renal artery with absorbable suture (e.g., polydioxanone, polyglyconate, glycomer 631, poliglecaprone 25) or nonabsorbable suture (e.g., cardiovascular silk) close to the abdominal aorta to ensure that all branches have been ligated. Consider placement of a transfixation suture if the artery is larger than 3 to 4 mm in diameter. Identify the renal vein and ligate it similarly. The left ovarian and testicular veins drain into the renal vein and should not be ligated in intact dogs. Avoid ligating the renal artery and vein together to prevent the formation of an arteriovenous fistula. Ligate the ureter near the bladder with a simple encircling ligature. Remove the kidney and ureter and, after procuring appropriate culture specimens, submit them for histologic examination.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Describe the nephrotomy technique with emphasis on the possible methods of closure
“Locate the renal vessels and temporarily occlude them with vascular forceps, a tourniquet, or an assistant’s fingers. Mobilize the kidney to expose the convex lateral surface. Make a sharp incision along the midline of the convex border of the kidney capsule, then bluntly dissect through the renal parenchyma, ligating renal vessels as necessary (Fig. 24.5). Culture the renal pelvis. Remove the calculi and flush the kidney with warm saline or lactated Ringer’s solution. Assess the ureter for patency by placing a 3.5-Fr soft rubber catheter down the ureter and flushing it with warm fluids. Close the nephrotomy by apposing the cut tissues and applying digital pressure for approximately 5 minutes while restoring blood flow through the renal vessels (sutureless technique). As an alternative, appose the capsule with a continuous pattern of absorbable suture material (see Fig. 24.5). If adequate hemostasis is not achieved, or if urine leakage is a concern, place absorbable sutures through the cortex in a horizontal mattress fashion (see previous comments and Fig. 24.5). Then, suture the capsule in a continuous pattern with absorbable suture. Replace the kidney in its original location. Sutures may be placed in the peritoneum where the kidney was elevated to help stabilize it…]”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
You represented with a large breed female dog of 10 months of age with a history of intermittent urinary incontinence. This dog was spayed three months ago. Besides hormone related sphincter incontinence, what is your second most likely differential diagnosis?
Ectopic ureters
A skilled ultrasoundnographist will be able to diagnose ectopic ureters by identifying and following the ureter past the level of the trigone. What is currently considered the test of choice for the diagnosis of urogenital abnormalities?
“CT excretory urography is the most sensitive method for diagnosis of ectopic ureters, and if available, should be considered the imaging modality of choice (Fig. 24.18). In a recent study comparing CT findings with cystoscopic and/or surgical findings, reviewers correctly identified 20 of 20 (100%) ureters as normal or ectopic based on the CT findings.6 Common abnormalities observed in dogs with intramural ectopic ureters include lack of a normal ureterovesicular junction, a urethral-ureteral orifice location, and lack of ureteral divergence.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What causes other than ectopic ureters should you rule out in young versus older patients prior to considering tests for ectopia?
- Behavioral (submissive) incontinence
- Urge incontinence
- Neurogenic incontinence
- Hormonal responsive incontinence
“Ureteral ectopia should be seriously considered in any young animal presented for incontinence or any older animal which has had incontinence since it was young. Behavioral incontinence is also common in young animals because of exaggerated submissiveness. Other causes of incontinence include urge incontinence (associated with inflammation or infection), neurogenic disorders (e.g., lower and upper motor neuron disorders or reflex dyssynergia), anatomic outflow obstruction (e.g., paradoxic incontinence), and urethral sphincter incontinence (e.g., hormone-responsive incontinence). Behavioral, urge, neurogenic, and hormone-responsive incontinence should be eliminated before tests for ectopia are considered in older animals.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What are the three most common drugs utilized in the treatment of urinary sphincter leakage?
Phenylpropanolamine (alpha-adrenergic agonist, weak beta adrenergic agonist. Leads to the release of norepinephrine and inhibits norepinephrine reuptake in the postsynaptic membrane, thereby increasing smooth muscle tone)
Ephedrine (Al[ha and beta adrenergic agonist, also promoting the release and inhibiting the reuptake of norepinephrine. POTENTIALLY LETHAL AT 10 MG/KG)
Diethylstilbestrol (synthetic estrogen)
What precautions (4) should always be taken when performing a nephrectomy?
1) explore the entire abdomen, particularly the opposite kidney for evidence of disease
2) locate the contralateral ureter to make sure it is not inadvertently ligated
3) remove the entire ureter associated with the kidney being removed
4) handle the neoplastic kidney very carefully and ligate the renal vein first to prevent seating of neoplastic cells via the vasculature or a directly into adjacent tissue
What are the most common complications associated with nephrectomies? (4)
Hemorrhage
Urine leakage
AKI in patients with pre-existing CKD
Inadvertent ligation of the contralateral ureter
What is the most common cause of hydronephrosis?
Ureteral outflow obstruction 
Renal abscesses are rare in dogs. What diseases are they commonly associated with and what is the most commonly isolated bacterial agent?
“Although few cases have been reported in dogs, renal abscesses have been associated with pyelonephritis, hyperadrenocorticism, diabetes mellitus, and renal biopsy. Most renal cortical abscesses are unilateral and Staphylococcus spp. is the most commonly isolated causative agent in dogs and cats.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Perinephric abscess is often associated with significant mortality despite aggressive therapy (drainage, surgical intervention, antibiotics). Provided that the condition can be diagnosed expediently and that renal function remains adequate, what is the recommended treatment for these lesions?
Nephrectomy
Urinary obstruction and uroperitoneum are considered medical emergencies, not surgical emergencies. Why?
“Urinary obstruction and uroperitoneum are medical emergencies, not surgical emergencies. Hyperkalemia associated with these conditions makes the animal prone to cardiac arrhythmias; therefore fluid and electrolyte abnormalities should be corrected before anesthesia.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
List three steps that should always be taken when performing a cystotomy
1) obtain a sample of mucosa for a bacterial culture
2) check the Apex for diverticulum and excise if present
3) Pass a urinary catheter down the urethra to verify patency
Describe the surgical approach and recommended therapy for a transected membranous (pelvic) urethra
“Perform a caudal ventral midline abdominal incision and, if necessary, a pubic symphysiotomy or bilateral pubic and ischial osteotomy (see later). Locate the transected ends of the urethra and debride them. Minimize dissection around the urethra and bladder to prevent damage to the vascular or nerve supply to these structures (Fig. 25.11). Suture the ends with six to eight absorbable interrupted sutures over a transurethral catheter (preferably a Foley catheter or other soft catheter). Leave the catheter in place for 7 to 10 days. If the urethral tissues do not hold suture because of prolonged urine extravasation and subsequent tissue devitalization, delayed repair is indicated. Place a transurethral catheter to divert urine flow for 5 to 7 days. If a catheter cannot be placed from the penile orifice into the bladder, pass a catheter from the bladder into the traumatized tissue, tie it to a catheter placed from the penile urethral orifice, and use it to pull the penile catheter into the bladder. If the urethra does not heal completely in 7 to 10 days, or if stricture occurs, resect the urethral ends and suture them over a catheter, as described for primary repair.
”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Describe the technique for closure of a pre-scrotal urethrotomy
“Using 4-0 or 5-0 monofilment absorbable matetial, Place the first layer in the urethral mucosa and corpus spongiosum, then appose subcutaneous tissue and skin with simple interrupted sutures or a continuous subcuticular suture pattern.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What are the four types of urethrostomy performed in dogs?
“Depending on the site of the lesion, ureterostomy can be prescrotal, scrotal, perineal, or prepubic in dogs.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the recommended length of an urethral incision for urethrostomy?
“The length of the urethral incision should be six to eight times its luminal diameter. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Describe the technique for a perineal urethrotomy in the dog
“For perineal urethrotomy, make a midline incision over the urethra, midway between the scrotum and the anus. (A) Identify the retractor penis muscle, elevate it, and retract it. (B) Separate the paired bulbospongiosus muscles at their raphe to expose the corpus spongiosum. (C) Incise the corpus spongiosum to enter the urethral lumen. (D) Close the urethra with simple interrupted absorbable sutures. Place the first layer in the urethral mucosa and corpus spongiosum; appose subcutaneous tissue and skin with simple interrupted sutures or a continuous subcuticular suture pattern.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Why is perineal urethrostomy rarely ever performed in dogs?
Frequently causes unacceptable urine scalding
The surrounding cavernous tissue is large at this location, and hemorrhage can be profuse
The urethra is deep at this location, making it difficult to obtain a tension free closure between skin and mucosa (may result in dehiscence)
Describe the technique for perineal urethrostomy in cats
“Place a purse-string suture in the anus, and catheterize the penis if possible. Place the cat in dorsal or ventral recumbency. If the cat is placed in dorsal recumbency, pull the pelvic limbs forward to improve access to the perineal region. Dorsal recumbency allows for cystotomy and perineal urethrostomy without having to reposition the cat. Make an elliptical incision around the scrotum and prepuce, and excise them. Place an Allis tissue forceps on the end of the prepuce or around the catheter to help manipulate the penis. Free the penis and the distal urethra from the surrounding tissue on either side (Fig. 25.22A). Extend the dissection ventrally and laterally toward the penile attachments at the ischial arch. Elevate the penis dorsally, and sharply sever the ventral penile ligament. Then, transect the ischiocavernosus muscles (see Fig. 25.22B) and the ischiourethralis muscles at their insertion on the ischium to avoid damaging branches of the pudendal nerves and to minimize hemorrhage. Reflect the penis ventrally to expose the dorsal surface. Locate the bulbourethral glands proximal and dorsal to the bulbospongiosus muscle and cranial to the severed ischiocavernosus and ischiourethralis muscles (see Fig. 25.22C). Avoid excessive dorsal dissection to prevent damage to[…]”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Ureterocolic anastomosis are considered salvage procedures in cases of trigone neoplasia when complete cystectomy is necessary. These procedures are typically avoided in favor of stenting techniques due to the high risk of complications. List the most common complications associated with the procedure?
“Complications associated with ureteral anastomosis in the bowel include reabsorption of electrolytes and nitrogenous waste products, upper UTI, and neurologic dysfunction. Azotemia, hyperammonemia, hyperchloremia, and metabolic acidosis are also common after these procedures.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
List a commercial xenograft that has been successfully used with minimal complications for the reconstruction of large portions of the urinary bladder in dogs
“porcine small intestine submucosa grafts”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What are the recommended methods for treating a partial urethral laceration (urethral continuity not completely disrupted) versus a complete urethral laceration? What are the expected healing times and possible complications?
If urethral continuity is not completely disrupted, the urethra will regenerate in as little as seven days. Urinary diversion via urethral catheter or tube cystostomy are indicated to avoid urine extravasation. Urine leakage, particularly if infected, can delay healing and promote periurethral fibrosis and stricture.
When complete transaction of the urethra occurs, primary anastomosis over an indwelling catheter should be performed to decrease the likelihood of stricture formation. The catheter should be left in place for 3 to 5 days. 
Proteus mirabilis is known to produce a different urinary environment in comparison to E. coli. What is the difference? How does it matter when it comes to choosing a suture material for the closure of the urinary bladder or urethral defect?
“Most sutures appear to lose tensile strength faster in alkaline urine (such as that seen with Proteus infections) than in infected acidic urine or sterile urine. Polyglycolic acid, polyglactin 910, and poliglecaprone 25 are rapidly degraded in infected urine; polydioxanone, polyglyconate, and glycomer 631 are acceptable for use in sterile bladders and in those infected with E. coli. However, use of any suture that is degraded via hydrolysis may be risky when the bladder is infected with Proteus spp. (see also p. 61) because monofilament absorbable sutures have been shown to degrade within 7 days in Proteus mirabilis-inoculated urine in vitro.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Emergency surgery is rarely ever indicated for patients with urinary bladder or urethral rupture caused by trauma. What initial approach should be taken in these patients?
“Immediate surgery is contraindicated in animals with uroabdomen that are hyperkalemic or uremic. In general, emergency surgery is rarely appropriate for animals diagnosed with uroabdomen. Patients should first be treated medically to normalize electrolytes and acid base, and to decrease circulating nitrogenous waste products. Intravenous fluids should be given and abdominal drainage and urethral catheterization performed (see p. 699). A large over-the-needle catheter (14-gauge) can be placed in the ventral abdomen under local anesthesia (sedate if necessary) to allow drainage for 6 to 12 hours. This will stabilize most animals with previously normal renal function.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
When urine leaks into the abdominal cavity, some nitrogenous waste products and electrolytes are reabsorbed across the perineal membrane while others are not due to their molcular size. Explain what happens to BUN creatinine and potassium in these cases. How can measurement of these parameters help us diagnose uroabdomen and what are the “cutoff” values for each?
“Urea rapidly equilibrates across the peritoneal surface, whereas larger molecules (e.g., creatinine) cannot pass back into the bloodstream, and they remain concentrated in the abdominal fluid.
“Diagnostic
Creatinine: Abdominal fluid: peripheral blood ≥2
Suggestive
Creatinine: Abdominal fluid: peripheral blood >1 but <2
Potassium: Abdominal fluid > peripheral blood”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the reported incidence of uroabdomen versus hemoabdomen in dogs with a traumatic pelvic fracture (2016 study)
Uroabdomen: 3.6%
Hemoabdomen: 32.5%
What are the alpha blocker and the somatic muscle relaxant typically utilized to decrease urethral sphincter tone?
Phenoxybenzamine
Diazepam
What is the prognosis for patients diagnosed with urinary bladder rupture secondary obstruction?
Possibly guarded because most of the urinary bladder may be necrotic
Explain the pathophysiology of struvite calculi formation due to UTI’s in dogs
“UTIs with urease-producing bacteria are an important cause of struvite calculi in dogs. These bacteria split urea to ammonia and carbon dioxide. Hydrolysis of ammonia forms ammonium ions and hydroxyl ions, which alkalinize the urine and decrease struvite solubility. Bacterial cystitis also increases organic debris, which can serve as a nidus for crystallization. Female dogs tend to have more struvite-containing calculi than male dogs, most likely owing their propensity for UTIs. Feline struvite formation usually occurs without UTI.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What are possible risk factors for the development of calcium oxalate cristaluria/calculi?
Defective tubular resorption of calcium
Primary hyperparathyroidism
Lymphoma
Hypervitaminosis D
Diet rich in oxalates (high carbohydrate content)
Any condition leading to acidic urine or hypercalcemia
Urate calculi are more commonly observed in what breed? What is the pathophysiology for such tendency?
What disease condition (congenital) can also lead to the formation of these calculi?
Dalmatians
Ammonium acid urate is derived from metabolic degradation of endogenous purine ribonucleotides and dietary nucleic acids. A normal dogs these by products are converted into allantoin for excretion (>90%). Dalmatians have defective hepatic transport of uric acid, resulting in decreased production of allantoin and increased urinary excretion of uric acid.
PSS can I also lead to urate calculi
What drug can be used to reduce the chance of recurrence of urate calculi in dalmatians? What if a PSS is present?
Allopurinol
Correct PSS
What dog breeds are predisposed to silicate calculi?
German shepherds and English Sheepdogs
What is the most sensitive method for finding urethral and urinary bladder stones (even better than ultrasound)
“Double-contrast cystography/urethrography is probably the most sensitive method for finding stones (even better than ultrasound).”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is considered the best method to avoid recurrence of urethral obstruction in dalmatians diagnosed with urate calculi?
“Cystotomy plus scrotal urethrostomy (p. 689) may be the most effective treatment in preventing recurrence of clinical signs in Dalmatians with urate calculi. Recurrence is common when a cystotomy alone is performed.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What dog breeds are predisposed to developing cystine urinary stones?  What drug can be used to attempt medical dissolution? What precautions must be taken if this drug used to be used after surgical removal of calculi?
Dachshunds, basset hounds, English bulldogs and others
D-penicillamine;  “Penicillamine may inhibit wound healing and should not be initiated earlier than 2 weeks after surgery. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the reported failure to remove all stones after cystotomy?
20% (Grant, DC et al, JAVMA 2010)
Urethral prolapse can be treated via urethropexy or surgical ressection of the prolapsed urethra (or both). What’s the prognosis with and without surgical therapy? Whats the reported recurrence and hemorrage rates after surgical treatment? what can be done to decrease this chance?
“Without surgery, the prolapse will not spontaneously resolve. A 2014 study found a recurrence rate of 57%; the likelihood of recurrence was reduced when postoperative sedation was used (e.g., acepromazine or butorphanol).14 Postoperative hemorrhage occurred in 39% of dogs; hemorrhage was less common when a simple continuous pattern was used instead of a simple interrupted.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Rhabdomyosarcomas are rare urinary tract tumors of dogs. What is their biological behavior?
“Rhabdomyosarcomas are uncommon, highly malignant tumors of striated muscle that may develop from pluripotent stem cells of the primitive urogenital ridge; they are remnants of the Müllerian or Wolffian ducts.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the biological behavior of TCC in dogs?
“Most bladder tumors are malignant, and metastasis to the medial iliac lymph nodes and lungs is common. Local extension to the ureters and/or the urethra is also common.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
TCC are the most common malignant neoplasia of the urinary bladder of dogs and cats. List 5 other malignant and two benign tumors also occasionally observed.
“other malignant bladder tumors include squamous cell carcinoma, adenocarcinoma, fibrosarcoma, leiomyosarcoma, neurofibrosarcoma, rhabdomyosarcoma, and hemangiosarcoma. Fibroma, leiomyoma, hemangioma, rhabdomyoma, myxoma, and neurofibroma are benign bladder tumors. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What condition presents similar clinical signs (stranguria, hematuria, pollakiuria, vaginal discharge) to urethral neoplasia? How are they differentiated and how is this inflammatory condition treated?
“Proliferative urethritis and granulomatous inflammation of the urethra in female dogs may cause clinical signs similar to those of urethral neoplasia (e.g., stranguria, hematuria, pollakiuria, vaginal discharge, and/or urinary obstruction). Neoplasia and granulomatous inflammation may be differentiated by cytologic evaluation of urethral aspirates or surgical biopsies. The cause of granulomatous urethritis is unknown. Affected dogs may respond favorably to immunosuppressive therapy (e.g., prednisone or prednisone plus cyclophosphamide) plus antibiotics.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Is there a gender or breed predisposition for urinary bladder neoplasia in dogs?
Female dogs and male cats are at a higher risk for bladder cancer
Shetland sheep dogs, beagles, collies and terriers, particularly Scottish terriers
What paraneoplastic syndrome may be seen in a dog with TCC?
“Lameness may be associated with hypertrophic osteopathy paraneoplastic syndrome in dogs with TCC”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Describe the technique for transurethral biopsy that can be used for the diagnosis of urinary bladder TCC
“Transurethral biopsy using a sterile urinary catheter is often diagnostic. First, insert a finger into the rectum. Then, advance the largest urinary catheter that easily passes through the urethra until the tip is digitally felt to advance just to the point where the thickening or mass is palpated. At that point, apply negative pressure. If urine is obtained, empty the bladder. After the bladder is emptied, or if negative pressure is present to begin with, establish 8 to 12 mL of negative pressure with a syringe that has 10 mL of sterile saline in it, while pulling the catheter tip back out through the thickened area. Once the catheter tip is clearly out of the affected area, remove the catheter from the urethra, place the tip in a clot tube, and blow the tissue fragments in the tip out by forcing saline out through the catheter. Examine the fluid, and retrieve tissue fragments and use them to make squash cytology preparations. In the case of female dogs with severe obstruction of the distal urethra, the most that may be possible is to insert a small, stiff polypropylene catheter a few millimeters into the urethra (which is as far as is possible[…]”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What precaution should always be taken immediately after the surgical excision of a bladder TCC (prior to closure)?
“Transplantation of TCC to the subcutaneous tissue of the surgical incision has been reported in dogs; therefore the same instruments used for biopsy or resection of a bladder tumor should not be used on other tissues.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the overall prognosis for dogs with malignant neoplasia, particularly TCC) affecting the lower urinary tract?
“Because of the malignant nature of most lower urinary tract tumors, the prognosis is guarded. Reported median survival times do not exceed 1 year, regardless of treatment modality. With aggressive surgery, urethral tumors may have a better prognosis than bladder tumors. Chemotherapy may allow dogs with bladder tumors to survive for significantly longer periods than if they undergo surgery. Deracoxib and vinblastine have been shown to have antitumor activity against TCC in dogs.16,17 For most owners, piroxicam as monotherapy or in conjunction with other agents may be the most appropriate medical therapy. The benefits of radiation therapy and photodynamic therapy in dogs are still being evaluated. Cystostomy tube placement in dogs with known or suspected TCC typically resolves stranguria, and most owners are satisfied with the procedure. UTIs are a common complication.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Ureterocolic anastomosis  is typically recommended for urine diversion after total cystectomy, what is unfortunately frequently associated with adverse effects such as azotemia, hypochloremia, Pyelonephritis, etc. What alternative procedures have been shown to be better tolerated in dogs?
“In a case series of 10 dogs that underwent total cystectomy with urinary diversion to the prepuce or vagina, median survival was 385 days, and they had fewer gastrointestinal and neurologic complications associated with ureterocolonic anastomosis.4”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
List five possible causes of urinary incontinence
Neurogenic abnormality or anatomic outflow obstruction (paradoxical or overflow incontinence)
Hormone responsive (urethral sphincter mechanism incontinence)
Inflammation (urge incontinence)
Congenital abnormalities (ectopic ureters, congenital urethral sphincter incontinence)
Behavioral
Ectopic ureters can typically be diagnosed via cystoscopy, but those located near the trigone might be difficult to spot. What is the “gold standard“ for the diagnosis of these congenital abnormalities ?
“Computed tomography (CT) excretory urography is the most sensitive method for diagnosis of ectopic ureters, and if available, should be considered the imaging modality of choice. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
List 5 described techniques to correct (Improve?) Urethral sphincter incontinence
“colposuspension, cystourethropexy, collagen injection, AUS, and trigonal reconstruction ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Colposuspension is the surgery most commonly utilized to treat urethral sphincter mechanism incontinence in female dogs. Describe the technique
“Before performing surgery, place a large urethral catheter. Perform a caudal midline abdominal approach, and identify the vagina dorsal to the urethra. Use stay sutures or atraumatic forceps to manipulate the vagina cranially. Place two sutures of heavy gauge (0 to 2-0) nonabsorbable monofilament material through the vaginal wall on either side of the urethra to the prepubic tendon on either side of midline. Use the urethral catheter to prevent overtightening of the sutures, which may result in urethral obstruction. Close the abdomen routinely.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the reported recurrence rate after urethral obstruction in a cat?
“Recurrence of obstruction has been historically reported to occur in 20% to 35% of cases, regardless of the cause of obstruction. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Name five bacterial strains which are part of the normal vaginal flora of a dog
“α- and β-hemolytic Streptococcus spp.
Staphylococcus spp.
Proteus spp.
Escherichia coli
Bacillus spp.
Bacteroides spp.
Pasteurella spp.
Anaerobic enterococci
Mycoplasma”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the minimum progesterone concentration necessary to maintain pregnancy in a bitch? To what level must it fall for parturition to initiate?
“Progesterone greater than 2 ng/mL is necessary to maintain pregnancy. Progesterone must fall below 2 ng/mL to initiate parturition;”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What simple method can be used to evaluate vaginal anomalies, masses in injuries to the female genital tract?
“Positive contrast vaginography may help evaluate vaginal anomalies, masses, or injuries if digital examination does not adequately define the problem. Positive contrast vaginography using a Foley catheter and a water-soluble iodinated contrast agent is easily performed. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
In dogs - When is radiology useful to diagnose an enlarged gravid uterus? When can fetal skeletal mineralization be observed?
“Radiographically, an enlarged gravid uterus can be detected within 31 to 38 days and fetal skeletal mineralization by 45 days after the LH peak (within a mean of 0.5 days of onset of estrus) ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
In cats - when can radiology be used to reliably diagnose pregnancy? What do you expect to see?
“In cats, it is difficult to know when the LH peak has occurred because behavioral estrus is variable (1–21 days); therefore fetal skeletal mineralization, which is first detected at 25 to 29 days before parturition, is used to predict when parturition will occur.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
When can pregnancy be Reliably diagnosed via ultrasonography in cats and dogs?
“pregnancy diagnosis by ultrasound is uncomplicated at 30 days of gestation”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Most common bacterial isolate associated with pyometra
“Antibiotic choice should be based on culture and susceptibility or on expected pathogens in patients with pyometra, metritis, or bacterial prostatitis. Until culture results are available, antibiotics used to treat pyometra should be efficacious against Escherichia coli because this is the most common pathogen.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What are the ideal properties of an antibiotic to be used in the treatment of prostatitis? Give 2 examples
“Antibiotic selection for prostatic diseases should be based on culture results and expected blood-prostate barrier penetration. Antibiotics should be lipid-soluble (usually nonionized), nonprotein bound, and have a high pKa (degree of drug ionization; high pKa = more basic). Those with a high degree of lipid solubility are best at crossing the blood-prostate barrier. Antibiotics with a high pKa are less ionized at physiologic conditions and concentrate in the prostate. Prostatic infections produce acidic prostatic fluid that helps trap antibiotics in the fluid. Basic antibiotics that concentrate in the prostate include erythromycin, clindamycin, and trimethoprim (Box 26.3). Enrofloxacin and doxycycline achieve high prostatic fluid concentrations and are effective against some resistant gram-negative urogenital pathogens.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Discuss the location and anatomy of the canine ovaries
“The ovaries are located within a thin-walled peritoneal sac; the ovarian bursa is located just caudal to the pole of each kidney. The uterine tube or oviduct courses through the wall of the ovarian bursa. The right ovary lies further cranially than the left. The right ovary lies dorsal to the descending duodenum, and the left ovary lies dorsal to the descending colon and lateral to the spleen. Medial retraction of the mesoduodenum or mesocolon exposes the ovary on each side. Each ovary is attached by the proper ligament to the uterine horn and via the suspensory ligament to the transversalis fascia medial to the last one or two ribs. The ovarian pedicle (mesovarium) includes the suspensory ligament with its artery and vein, ovarian artery and vein, and variable amounts of fat and connective tissue. Canine ovarian pedicles contain more fat than feline ovarian pedicles, making it more difficult to visualize the vasculature. The ovarian vessels take a tortuous path within the pedicle. Ovarian arteries originate from the aorta. The left ovarian vein drains into the left renal vein; the right vein drains into the caudal vena cava. The suspensory ligament is a tough, whitish band of tissue[…]”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Prostatectomy is infrequently performed in veterinary patients. What are the two main reasons for this?
Prostatic tumors are frequently metastatic at the time of diagnosis
Prostatectomy frequently results in urinary incontinence
Subtotal prostatectomy can be performed as a palliative option for patients with prosthetic neoplasia. How much of the prostate can be removed without causing urinary incontinence?
85%
What is the main reported risk factor for post-spay urinary incontinence?
Body weight above 15 Kg (7 times more likely to become incontinent)
What are some of the known risk factors for neonate mortality?
“Neonate mortality is most commonly associated with emergency surgery, large litters, brachycephalic bitches, and poor anesthetic choices.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
How does spaying affect a dogs risk of developing mammary gland neoplasia?
“The risk of mammary tumors for dogs spayed before their first estrus is 0.05%. This risk increases to 8% after one estrus cycle and 26% after the second estrus.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
In general terms, how many times as likely to develop mammary gland neoplasia are dogs and cats intact versus spayed?
Seven times
What are the two most common malignancies associated with the uterus of dogs and cats? What is the overall reported incidence of these tumors?
“Uterine neoplasia is rare in the dog, with a reported incidence of 0.4% of all canine tumors, and it is even less common in cats (0.29%). Most tumors are incidental findings at necropsy or during abdominal exploration.”
“Leiomyoma and leiomyosarcoma are benign and malignant smooth muscle tumors, respectively, that may occur in the uterus. Uterine adenocarcinomas are malignant tumors of the uterine glands.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the prognosis for a benign and malignant uterine tumors treated via surgery?
“The prognosis following OHE is excellent for benign tumors and good for malignant tumors without evidence of metastasis or local infiltration. The prognosis for uterine adenocarcinomas is guarded because of its propensity to metastasize before diagnosis. The effectiveness of other treatment modalities for uterine tumors is unknown.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Discuss the pathogenesis of canine endometrial hyperplasia and pyometra. What is the reported risk of an intact bitch developing pyometra before 10 years of age?
“CEH and pyometra both develop during diestrus. Occasionally the diagnosis is delayed and unrecognized until anestrus. In dogs, the diestrual period of a normal, nongravid bitch lasts approximately 70 days. The uterus is influenced by progesterone produced by ovarian corpora lutea. Progesterone stimulates the growth and secretory activity of the endometrial glands and reduces myometrial activity. CEH is an abnormal uterine response that develops during diestrus (luteal phase of cycle) when there is high or prolonged ovarian production of progesterone or exogenously administered progesterone. Excessive progesterone influence or an exaggerated progesterone response causes the uterine glandular tissue to become cystic, edematous, thickened, and infiltrated by lymphocytes and plasma cells. Fluid accumulates in endometrial glands and the uterine lumen with CEH. Uterine drainage is hindered by progesterone inhibition of myometrial contractility. This abnormal uterine environment allows bacterial colonization to cause pyometra. Administration of estrogen increases the risk of pyometra during diestrus. The risk of an intact bitch developing pyometra before 10 years of age is nearly 25%.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Why are cats less predisposed to pyometra then dogs? What can increase their chance of developing this disease?
“Feline pyometra is less frequent than canine pyometra because development of luteal tissue requires copulation or artificially induced ovulation; however, cats treated with progestins for skin disease have an increased incidence of pyometra.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the most common bacterial agent associated with pyometra? list three other organisms also occasionally isolated.
“E. coli is the most common organism identified in canine and feline pyometra, but mixed infection is also common. E. coli has an affinity for the endometrium and myometrium. Bacterial invasion is thought to be opportunistic because the most commonly isolated organisms are also normal vaginal flora ”
“Escherichia coli
Staphylococcus aureusa
Streptococcus spp.a
Pseudomonas spp.a
Proteus spp.a
Pasteurella spp.
Klebsiella spp.
Haemophilus spp.
Serratia spp.
Moraxella spp.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Pyometra is frequently associated with systemic inflammatory response syndrome (SIRS). Two of four main physiologic criteria must be present to diagnose the condition. List the 4 criteria. 
“Heart rate: >160 beats/min
Temperature: >103.5°F (40°C) or <100°F (38°C)
Respiration: >20 breaths/min or partial pressure of CO2 <32 mm Hg
White blood cell count: >12,000/µL, <4000/µL, or >10% band neutrophils”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Patients with pyometra may have prerenal azotemia or various types of renal impairment. Discuss the most common renal abnormalities, the proposed pathophysiology and likely prognosis with adequate treatment
“Patients with pyometra may have prerenal azotemia, primary glomerular disease, reduced tubular concentrating ability, tubular interstitial disease, reduced glomerular filtration, and/or concurrent renal disease unrelated to the pyometra. Prerenal azotemia is due to poor perfusion, dehydration, and shock. Primary glomerular disease occurs secondary to immune-complex glomerulonephritis. Bacterial antigens also interfere with renal tubular concentrating ability. Once the bacterial antigen is removed, these changes typically resolve and normal renal function returns. Reduced tubular concentrating ability is from inhibition of antidiuretic hormone at the level of the renal tubule by bacterial endotoxins, obligatory solute load from decreased glomerular filtration rate, and other unknown factors. Normal tubular concentrating ability usually returns 2 to 8 weeks after OHE. Hepatocellular injury may be secondary to intrahepatic cholestasis and retention of bile pigments, toxicity from sepsis and endotoxemia, and/or poor perfusion.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Anemia may be observed in cases of pyometra. What is the proposed pathophysiology?
“Anemia may be caused by chronic inflammation suppressing erythropoiesis, loss of red cells into the uterine lumen, hemodilution, or surgical blood loss. Nonregenerative anemia should spontaneously resolve a few weeks after OHE. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
List three antibiotic choices that would be adequate for a patient with pyometra while culture results are still pending
“Cefazolin (Ancef, Kefzol)
22 mg/kg IV, SC, IM q8h
Cefoxitin (Mefoxin)
Dogs: 30 mg/kg IV q6–8h
Cats: 22–33 mg/kg IV, IM q8h
Amoxicillin Plus Clavulanate (Clavamox)
Dogs: 12.5–25 mg/kg PO q12h
Cats: 62.5 mg/cat PO q12h
Ampicillin Plus Sulbactam (Unasyn)
50 mg/kg IV q8h
Ampicillin
22 mg/kg IV, IM, SC q6–8h
Enrofloxacin (Baytril)
Dogs: 7–20 mg/kg PO, IV q24h (dilute and give slowly over 30 min if given IV)
Cats: 5 mg/kg PO q24h
”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the typical Signalment of a bitch with vaginal prolapse or hyperplasia? In what phase of the reproductive cycle is this condition likely to develop?
“Although rare, vaginal prolapse/hyperplasia is most common in large-breed dogs. It most commonly occurs in young bitches (≤2 years) during one of their first three estrus cycles. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the most common benign tumor of the vulva/vagina of dogs? what is the typical clinical presentation?
“Fibroleiomyoma is the most common benign tumor. Fibroleiomyomas originate around the urethral papilla and are usually pedunculated, smooth, firm, and pale. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Patients with uterine prolapse may present in hypovolemic shock. What is the most likely cause?
Rupture of the uterine artery
What is the reported incidence of benign prosthatic hyperplasia in intact males over the age of 9 years?
95%
Testosterone levels decline with age, but the incidence of BPH in intact males tends to increase. How can you explain this fact?
“Dihydrotestosterone enhances growth in both prostatic stromal and glandular components. Testosterone declines with age, but estrogen levels remain the same and induce nuclear dihydrotestosterone receptors, which may increase the sensitivity of the prostate to dihydrotestosterone.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What are the two types of prostatic hyperplesia? At what age are they most likely be observed?
Glandular hyperplasia, dogs as young as 1 year of age, peaks at 5-6 years
Complex hyperplasia, dogs as young as 2 years, peaks at 8-9 years
When is the prostate considered enlarged on a lateral abdominal radiograph?
“The prostate is considered enlarged if it is greater than 70% of the distance between the sacral promontory and the pubis on lateral radiographs”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What are the ultrassonographic and computed tomography appearance of a prostate affected by BPH?
“Ultrasonographically, hyperplasia is seen as diffuse, symmetric prostatic involvement, often with multiple, small cysts. Overall glandular echogenicity is normal to increased. Small areas of decreased echogenicity may be seen if cystic hyperplasia is present.
Typical features seem in CT images of BPH include symmetric prostatomegaly and heterogeneous prostatic parenchyma. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
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How is benign prostatic hyperplasia (BPH) diagnosed?
“Definitive diagnosis of BPH requires histopathology, but typically a presumptive diagnosis is made based on historical information, physical examination findings, and ultrasonographic examination.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
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How are prostatic or periprostatic cysts treated?
Drainage or excision and castration
What is the relationship between Sertoli cell tumors (testicles) and the development of prostatic abscesses?
“Sertoli cell tumors predispose the prostate to squamous metaplasia, which can lead to prostatic cysts that can then abscess.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the recommended medical treatment (which drug) four benign prosthetic hyperplasia if the owner declines castration? Why should estrogen not be used?
“Finasteride is a synthetic steroid type II 5-alpha reductase inhibitor that significantly decreases dihydrotestosterone (approximately 58%) without affecting serum testosterone or semen quality, and reduces prostate diameter (approximately 20%) and volume (approximately 43%) (see Table 26.7); it is currently the drug of choice in dogs for which castration is not an option. Estrogen therapy reduces prostatic size but is not recommended because it causes infertility, squamous metaplasia, abscessation, and aplastic anemia. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
How much can you expect the prostate of a patient with BPH to shrink by 3 weeks post castration?
50%
What tumors are associated with the development of prostatic parenchymal cysts?
“Sertoli cell tumors or exogenous estrogens may cause squamous metaplasia, which occludes ducts, causing secretory stasis with progressive acinar dilation. Cysts coalesce as they enlarge and are surrounded by dense collagen that can ossify. Small cysts often become confluent, forming larger cavities.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
List three possible differentials for prosthetic calcification
Parenchymal prosthatic cyst
Paraprostatic (Periprostatic) cysts
Neoplasia 
List the six most common prostatic tumors
LATUSH
Leiomyosarcoma
Adenocarcinoma
Transitional cell carcinoma
Undifferentiated carcinoma
Squamous cell carcinoma
Hemangiosarcoma
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the reported incidence of prostatic neoplasia in dogs?
(0.2%–0.6%)
What kind of prostatic neoplasia is more likely to occur in a sexually intact versus a castrated dog?
“Well-differentiated adenocarcinomas are found more frequently in sexually intact dogs, whereas histologic types with more anaplasia and TCC are more common in castrated dogs. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the expected biologic behavior of canine prostatic carcinomas? discuss metastatic potential (sites) and clinical signs
“Prostatic carcinomas are locally invasive and metastasize early to regional lymph nodes (iliac, pelvic, and sublumbar), lung, and bone. They frequently invade bone, bladder, colon, and surrounding tissue by direct extension. Other metastatic sites include the liver, spleen, kidney, heart, adrenal glands, skeletal muscle, and subcutaneous tissue. Bone involvement may cause pain or pathologic fractures. Hypertrophic osteopathy has occasionally been associated with prostatic tumors. Prostatic enlargement causes compression and partial obstruction of the colon, rectum, and sometimes urethra. Pitting edema of the pelvic limbs may occur secondary to lymphatic invasion. Most tumors involve the trigone and urethra and have metastasized at the time of diagnosis. The behavior of feline prostatic tumors is unknown.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the typical signalment for a dog affected by prostatic neoplasia? Is this more likely in a sexually intact or castrated dog?
“Prostatic neoplasia occurs in both intact and neutered males, but is more common in neutered males. Medium to large-breed dogs, such as doberman pinschers, Shetland sheepdogs, Scottish terriers, beagles, German shorthaired pointers, Airedale terriers, and Norwegian elkhounds are overrepresented. The average age of occurrence is 10 years. Prostatic tumors are very rare in cats.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
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You are presented with a middle-age canine showing clinical signs of scrotal dermatitis, testicular enlargement and discomfort as well as lumbar discomfort. On radiographs you suspect discospondylitis. What infectious agent should you look for as part of your diagnostic profile?
“Be sure to test for Brucella canis infection in dogs with unexplained scrotal or testicular disease.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What breed has been reported to have a familial position to hypospadias?
“familial predisposition has been suggested in Boston terriers. The defect is present at birth.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Describe the medical and surgical treatment of comminuted or displaced os penis fractures
“Displaced fractures may be splinted with an indwelling polypropylene urethral catheter spanning the os penis and sutured to the tip of the urethra. More comminuted fractures may be stabilized with small plates, or the penis may be amputated.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What layer must be included in the suture line when repairing a penile laceration to minimize the chance of hemorrhage?
“Bleeding from small penile punctures or lacerations during penile engorgement is minimized by suturing the tunica albuginea.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Blood supply to the urinary bladder
“The bladder receives its blood supply from the cranial and caudal vesical arteries, which are branches of the umbilical and urogenital arteries, ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Percentage of CaOx calculi expected to recur in dogs Vs cats. Time frame.
“Up to 50% of calcium oxalate uroliths recur within 3 years in dogs but only 7% recur in cats.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
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Reported success rate of colposuspension for the treatment of USMI
54 to 82% completely continent (two studies)
86% client satisfaction
Is ultrasound-guided fine needle aspirate of ovarian lesions recommended? Why?
“Transabdominal needle biopsy of the ovaries is not recommended because of the propensity of many ovarian tumors to implant and grow on the peritoneal surface.21”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Ovarian tumors are rare in dogs, and split in roughly two groups accounting for 50% of tumors each. What tumors are contained in these groups?
“Epithelial cell tumors include papillary adenoma and adenocarcinoma, cystadenoma, and undifferentiated carcinoma. These tumors constitute 40% to 50% of reported canine ovarian neoplasms”
“The most common sex cord stromal tumor is the granulosa cell tumor, which accounts for approximately 50% of ovarian tumors in several reviews.218 These tumors may produce estrogen, progesterone, or both. They are usually unilateral, firm, and lobulated with cysts and can grow quite large.76,303 Up to 20% of granulosa cell tumors metastasize.218”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What is the typical presentation for bitches with granulosa cell tumors?
“Bitches with granulosa cell tumors may present with clinical signs of persistent proestrus or estrus, cystic endometrial hyperplasia, or pyometra. ”
“granulosa cell tumors are often large and unilateral and produce hormones. They metastasize to peritoneum, lumbar lymph nodes, omentum, diaphragm, kidney, spleen, liver, and lungs”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What is a possible serious systemic consequence of granulosa cell tumors in bitches? (Other than metastasis(
“Dogs with estrogen-secreting granulosa cell tumors may develop bone marrow aplasia and, possibly, irreversible pancytopenia.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Ovarian cysts can be non-functional or functional. The former are typically remnants of embryonic structures. What is the origin of the latter and potential consequences?
“Ovarian follicular cysts are lined with granulosa cells. Follicular cysts that secrete significant amounts of estrogen produce prolonged proestrus; if a small amount of progesterone is also secreted, they produce signs of prolonged estrus. Luteinized cysts secrete only progesterone, resulting in prolonged diestrus. Functional ovarian cysts are more commonly seen in dogs younger than 3 years of age and cats younger than 5 years of age.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Typical clinical presentation for functional follicular cysts in dogs and cats
“In dogs, follicular cysts are associated with vaginal bleeding and attractiveness to males beyond the normal 21 to 28 days of an ovarian cycle.84,130 If the cyst is also progesterone producing, persistent standing heat is evident. Cats often show persistent estrus when follicular cysts are present.129 Physical examination findings are consistent with persistent proestrus or estrus and include an enlarged vulva (dogs) and vaginal bleeding of uterine origin.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What are the diagnostic essays that can be used to diagnose ovarian remnant syndrome?
“The diagnosis in dogs is based on a history of ovariohysterectomy and results of vaginal cytology that, if performed during standing heat, are indicative of estrogen dominance.130 Other diagnostic tests in dogs include hormone assays: remnant ovarian tissue is likely present if serum estradiol and progesterone concentrations exceed 15 pg/mL and 2 ng/mL, respectively.130 A single low luteinizing hormone concentration indicates functioning ovarian tissue in dogs.239 A high luteinizing hormone concentration is usually consistent with gonadectomy; however, false-positive results may occur.239 Anti-Müllerian hormone was recently shown to be diagnostic for ovarian remnant syndrome in an experimental canine model and useful for differentiating gonadectomy status in cats; it has the advantage of being independent of the ovarian cycle.16,374 In one study the location of the remnant was correctly identified in 9 of 12 animals on ultrasonography.18”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Average age and reported incidence of pyometra in intact bitches
“Pyometra is common in middle-aged intact bitches, with an average age of 8 years.145 Incidence in intact bitches is high: the risk for a bitch to be affected within 10 years of age is estimated to be 23% to 24%.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What is the proposed etiopathogenesis of pyometra? Most common bacterial agents involved?
“Hormone stimulation alone does not result in pyometra, indicating that pyometra development is multifactorial and involves hormonal and bacteriologic aspects. In dogs and cats the predominant bacteria in most studies is Escherichia coli. Other isolates include Pasteurella multocida, Pseudomonas spp., Proteus spp., Klebsiella spp., Streptococcus canis, Enterobacter cloacae, and many others.”
“Pyometra does not appear to be caused by prolonged or excessive progesterone production or changes in hormone receptors.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Patients with pyometra are frequently also affected by another infection. Where? With what frequency?
“Cystitis may occur in almost 70% of dogs with pyometra, and E. coli isolated from urinary bladder and uterus of individual affected dogs are phenotypically and genetically identical.Although the urinary tract may serve as a bacterial reservoir for ascending contamination during a susceptible stage in the estrus cycle,it seems more likely that purulent drainage from the uterus secondarily infects the dependent-positioned urinary tract.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Most common clinical signs associated with pyometra
“The most common clinical signs of pyometra in dogs include polyuria (71%), lethargy (71%), vomiting or inappetence (75%), and vaginal discharge (52% to 85%). In one study a majority of bitches (60%) showed three or more of these clinical signs. In another study, 47% of bitches with pyometra had gait abnormalities and lameness, as compared with 20% of the body-matched controls. Interestingly, the gait abnormalities resolved 2 to 4 days after ovariohysterectomy in most dogs.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
CBC abnormalities expected in a bitch with pyometra
“Common laboratory findings in bitches with pyometra include an inflammatory leukogram with marked increase in total white blood cell (WBC) count and usually a regenerative left shift.l Leukocytosis was reported in 68% of dogs with pyometra, with band neutrophils exceeding 3% in 83% of dogs.145 Normocytic, normochromic anemia is also common and is thought to result from erythrocyte loss into uterine exudate and decreased erythropoiesis. With anemia of chronic disease, lactoferrin and other acute phase reactants mediate an iron sequestration within the myeloid cells in the bone marrow, withdrawing iron from the normal erythropoiesis.78 Platelet counts are often mildly decreased and were less than 200,000/µL in 37% of dogs in one study.145 Alterations of the canine immune system during pyometra have been demonstrated by lymphocyte transformation test, indicating inhibition of lymphocyte activity.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Dogs with pyometra tend to have increased alkaline phosphatase (AP), bilirubin, cholesterol, AST and lactate (LD) levels. What is the proposed cause of these elevations?
“Increased AP, bilirubin, and serum cholesterol concentrations are thought to result from intrahepatic cholestasis.40 Increases in AST and LD concentrations are most likely derived from muscle breakdown, based on the fact that dogs with pyometra have increased concentrations of creatine kinase, a muscle enzyme, and decreased ALT concentrations, indicating that no hepatocellular damage has occurred.40,93,144,145,338 Additionally, liver biopsy specimens from dogs with pyometra have fatty infiltration and bile pigments, consistent with cholestasis, but no gross hepatocellular necrosis”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
When performing an OVH to treat pyometra, what is the recommended procedure regarding the remaining uterine stump?
“The uterine stump should not be oversewn to avoid leaving compromised tissue and foreign material (suture) in an infected site.356”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Treatment of choice for hematometra
“Hematometra should be treated by ovariohysterectomy if bleeding is clinically significant.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Does ovariohysterectomy affect milk production?
“Ovariohysterectomy does not affect postpartum milk production.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Briefly describe the typical clinical presentation, timing post-partum, medical and surgical treatment of metritis in the bitch.
“Acute metritis may result in severe systemic illness similar to pyometra but is associated with the postpartum, rather than diestrus, period. Twelve hours after delivery, healthy bitches may develop a fever (<40°C [104°F]) that lasts for 24 to 48 hours; however, any clinical signs of illness within 1 week of partus may indicate acute metritis.380 Postpartum metritis may be associated with dystocia, obstetric manipulations, devitalized uterine tissue, or retention of a fetus or placenta.133Clinical signs include foul-smelling, reddish brownish vaginal discharge (in contrast to the normal nonodorous lochia), anorexia, lethargy, fever, decreased maternal behavior, and decreased milk production.111,343 Vaginal smears are not diagnostic because degenerative neutrophils and phagocytized bacteria can be seen in healthy postpartum dogs or those with metritis or vaginitis.133,296 Changes on CBC (i.e., leukocytosis with a left shift, or leukopenia if severely ill) are associated with inflammation. A chemistry panel reflects dehydration and occasionally sepsis.133Treatment consists of rapidly instituted systemic antibiotic therapy. Anterior vaginal swabs for culture are ideally obtained before antibiotic administration. Penicillins, clindamycin, erythromycin, and cephalosporins are safe to use in pregnant or nursing bitches.128 Amoxicillin or ampicillin is usually initiated while awaiting culture results[…]”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Describe a practical surgical approach to uterine prolapse non-amenable to manual reduction/purse string
“the abdomen, perivulvar region, and prolapsed tissue can be surgically prepared and draped in. An ovariectomy is performed via midline laparotomy, and the mesometrium is disconnected from the uterus. The entire uterus is retracted out from the vulva and removed after ligation of the uterine body.33”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What is the basic criteria for the diagnosis dystocia?
- prolonged gestation
- lack of progression from stage 1 to stage 2 labor within 12 to 24 hours
- failure to deliver pups within 36 hours of rectal temperature falling below 37.8°C (100°F)
- signs of toxemia
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What are the ultrasonographic signs of fetal distress?
“Normal fetal heart rate in healthy fetuses at term is 220 beats/min or higher382,403 at normal birth or 142 to 162 beats/min in an anesthetized dam.267 Fetal heart rate below 150 to 180 beats/min in an awake dam has been considered a sign of severe fetal distress128,403 Absent fetal motion and presence of fetal bowel movements are also indicators of fetal distress.403”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Accurate of radiography for fetal number estimation at term
“Fetal numbers are accurately determined by radiologic examination in 93% of pregnancie”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
What are the main contraindications for medical management of dystocia?
“Contraindications to medical management include a history of more than 30 minutes of strong abdominal contractions without fetal expulsion, rectal or vaginal palpation findings indicative of obstruction, or diagnostic imaging indicative of fetal malformation or malposition. In addition, if ultrasonographic signs of severe fetal distress are present, a cesarean section should be performed without delay to avoid fetal death.”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Percentage of bitches with dystocia that require C-section
“Of bitches with dystocia, 60% to 65% require cesarean section.28,83”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
Serosanguineous vaginal discharge may be observed for up to 6 weeks post-partum (normal uterine involution). Uterine subinvolution may occur as a result of persistent fetal trophoblasts in placental sites, leading to vascular damage and hemorrhage. Healthy, non-anemic bitches may be managed conservatively. What is the recommended treatment if persistent anemia is present?
“Subinvolution primarily affects young bitches after their first or second litter. Usually, hemorrhagic vaginal discharge is the only abnormality found on physical examination and diagnostic testing. Diagnosis is partly based on ruling out other conditions that cause vaginal hemorrhage, such as metritis, vaginitis, proestrus, trauma, neoplasia, and coagulopathies. The presence of trophoblast-like cells on vaginal cytology may aid in diagnosis.394 If the bitch remains healthy and does not develop anemia, treatment is unnecessary, and the bitch remains fertile. No effective medical management has been reported; therefore bitches with persistent hemorrhage and anemia may require ovariohysterectomy.133”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
You are spaying a bitch and notice a congenital abnormality known and unicornuate uterus. What precaution should you take regarding the ovaries?
“In animals with unicornuate uterus, both ovaries are usually present, but the ipsilateral ovary may be smaller than normal and abnormally located, possibly as far cranial as the diaphragm.258,356 Other anomalies reported include atresia, septate uterine body, double cervix, and cornual fusion.248,273,356”
Excerpt From
Veterinary Surgery: Small Animal Expert Consult
Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS
https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401
This material may be protected by copyright.
In what phase of the reproductive cycle does pyometra develop in bitches? how long after estrus? How long does this phase last in a normal non-gravid bitch?
“CEH and pyometra both develop during diestrus. Occasionally the diagnosis is delayed and unrecognized until anestrus. In dogs, the diestrual period of a normal, nongravid bitch lasts approximately 70 days.”
“Pyometra usually occurs several weeks (1–4 weeks in cats, 4–8 weeks in dogs [mean, 5.7 weeks]) after estrus, or following mismating injections or exogenous administration of estrogens or progestins.”
Discuss the pathophysiology of pyometra and how it relates to CEH
“The uterus is influenced by progesterone produced by ovarian corpora lutea. Progesterone stimulates the growth and secretory activity of the endometrial glands and reduces myometrial activity. CEH is an abnormal uterine response that develops during diestrus (luteal phase of cycle) when there is high or prolonged ovarian production of progesterone or exogenously administered progesterone. Excessive progesterone influence or an exaggerated progesterone response causes the uterine glandular tissue to become cystic, edematous, thickened, and infiltrated by lymphocytes and plasma cells. Fluid accumulates in endometrial glands and the uterine lumen with CEH. Uterine drainage is hindered by progesterone inhibition of myometrial contractility. This abnormal uterine environment allows bacterial colonization to cause pyometra. Administration of estrogen increases the risk of pyometra during diestrus. The risk of an intact bitch developing pyometra before 10 years of age is nearly 25%.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Overall lifetime risk of an intact bitch developing pyometra before 10 years of age
“The risk of an intact bitch developing pyometra before 10 years of age is nearly 25%.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Why does the use of estrogen to prevent pregnancy increase the chance of pyometra?
“Estrogen increases the number of uterine progesterone receptors, which may explain the increased incidence of pyometra after estrogens are administered to prevent pregnancy.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Why are cats less frequently affected by pyometra? what type of therapy may increase the risk of this disease in cats?
“Feline pyometra is less frequent than canine pyometra because development of luteal tissue requires copulation or artificially induced ovulation; however, cats treated with progestins for skin disease have an increased incidence of pyometra.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
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Most common concomitant metabolic complication of pyometra and pathophysiologic mechanism
“ Hypoglycemia is common in canine pyometra. Sepsis and SIRS deplete glycogen stores, increase peripheral glucose use, and decrease gluconeogenesis. Transient hyperglycemia occasionally occurs because of excessive catecholamine and glucagon release. Progesterone-induced growth hormone production may cause persistent hyperglycemia and glucosuria. Judicious insulin treatment may be required in patients with persistent hyperglycemia (i.e., greater than 300 mg/dL) after appropriate medical and surgical treatment.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
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Name five of the most common systemic abnormalities observed in patients with pyometra
Hypoglycemia
Renal dysfunction
Hepatic dysfunction
Anemia
Cardiac arrhythmias
Coagulation abnormalities
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
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What is the clinical significance of leukopenia in a patient with pyometra?
“Leukopenia may indicate overwhelming infection and septicemia or uterine sequestration of neutrophils, and has been shown to be associated with an 18-fold increase in the likelihood of peritonitis in dogs with pyometra.7”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Discuss the pre-op management of a patient with pyometra
“Surgery should not be delayed more than a few hours while medical therapy (i.e., fluid therapy) is instituted, especially in patients with closed pyometra. Urine output, glucose, and arrhythmias should be monitored preoperatively. Hydration, electrolyte, and acid-base imbalances should be corrected before surgery, if possible (the prognosis is improved when azotemia is corrected before surgery). A broad-spectrum antibiotic effective against E. coli (e.g., cefazolin, cefoxitin, enrofloxacin, ampicillin plus sulbactam, and ticarcillin plus clavulanate; Box 26.21) should be given IV while awaiting antibiotic susceptibility results. Aminoglycosides are nephrotoxic and not recommended because of the prevalence of renal dysfunction with pyometra. Fluid input and urine output should be monitored to help assess renal function. Diuretics (e.g., furosemide [Box 26.22], 2–4 mg/kg IV, intramuscular [IM], or subcutaneous or 20% dextrose IV) may be administered in volume-overloaded patients with reduced urine production. Administration of antiarrhythmics may occasionally be necessary.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
Most common benign and malignant vaginal tumors of dogs
“Fibroleiomyoma is the most common benign tumor. Fibroleiomyomas originate around the urethral papilla and are usually pedunculated, smooth, firm, and pale. The most common malignant tumors are TVTs. These tumors tend to be broad-based, irregular, friable, and bleed easily. Malignant vulvar-vaginal tumors are often locally invasive and metastasize early to local lymph nodes. ”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
What is the most urgent consequence of uterine prolapse?
“Uterine prolapse may tear the broad ligament and uterine artery. Hemorrhage may lead to hypovolemic shock unless controlled quickly.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
How can vaginal prolapse/hyperplasia be differentiated from uterine prolapse?
“A fornix will be identified by inserting a probe or finger along the protruding mass if it is a vaginal mass or prolapse, but not if it is a uterine prolapse. The animal may be stable or show signs of hemorrhagic shock (e.g., pale mucous membranes, tachycardia, and weak pulses).”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
You are presented with a case of uterine prolapse and opt to amputate the prolapsed organ. What precaution must you take before proceeding?
“Catheterize the urethra during uterine amputation to prevent traumatizing it or the urethral papilla.”
Excerpt From
Small Animal Surgery E-Book
Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS
https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984
This material may be protected by copyright.
According to Dekerie et al (VetSurg 2022), what is the overall success rate (% of patients that recovered continence) of open and cystoscopically-guided correction of ectopic ureters? What technique was associated with fewest complications?
Overall 80% response. Incontinence can recite within 6 months but tends to respond to medical management.
- Cystoscopically-guided laser ablation was associated with fewer complications
Dekerle, B, Maurice, E, Decambron, A, Viateau, V, Maurey, C, Manassero, M. Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic-guided laser ablation. Veterinary Surgery. 2022; 51( 4): 568- 575. doi:10.1111/vsu.13807
Reported incidence of obstruction due to calculi in SUB 3.0 before and after the introduction of tetra-EDTA flush Q3months?
Before: 24% @ 463 days
After: 13% @ 476 days
The basis of penile erection is a profound increase in parasympathetic tone which drives increased blood flow through the internal pudendal arteries. Describe the two mechanistic steps involved in penile erection
1) Engorgement of the cavernosus bodies of the penis, as a result of increased arterial flow and decreased venous drainage
2) Compression of the dorsal penile vein against the ischial arch as a result of contraction of the ischiocavernosus and bulbospongiosum muscles
Name the most common urogenital congenital abnormality of dogs. From what embryonic abnormality does this condition result? What are the five clinically recognized variance? Is surgical therapy recommended?
Hypospadias
Failure of fusion of the urogenital folds and incomplete formation of the penile urethra
Glandular, penile, scrotal, perineal, anal
Surgical reconstruction is not recommended because the remaining urethra cranial to the orifice is typically abnormal. Excision of prepucial/penile remnants, bilateral orchiectomy with enlargement or maintenance of a current orifice in the scrotal or perineal region can be attempted in severe cases.
You are presented with middle-age male terrier with a history of dysuria and hematuria following an attempt to breed. The patient has penile swelling, bruising, and discomfort upon palpation. You obtain radiographs and diagnose a case of os penis fracture. the fracture is commuted. How would you treat this case? What is this patient’s prognosis?
Attempt to pass a urinary catheter beyond the fracture, bridging the entire length of the os penis. Keep the catheter in place for seven days. If passing a urinary catheter is not possible, open reduction, and internal fixation with a plate will be necessary. Ultimately a pre scrotal urethrostomy And penile amputation might be necessary if signs of urethral obstruction persist. This may occur as a result of the fracture itself, or due to bone formation. Prognosis with conservative management tends to be very good. Salvage procedures also tend to be effective.
