Kidney and Ureters Flashcards
What blood vessel do the renal arteries come off of?
Aorta
What % of nephroliths are Ca oxalates?
41%
What are the clinical signs of a nephrolithiasis?
Could be absent or non-specific. Depression, anorexia, hematuria, pain
How would you diagnose nephrolithiasis?
Radiographs, ultrasound
What is the criteria for treatment with nephrolithiasis?
Know the type of calculi, the location, and the effects
When would you need to perform surgery on a patient with nephrolithiasis?
Obstruction, infection created by the calculi
If the patient with nephrolithiasis is asymptomatic, what should you do?
Monitor/imaging, medical management
In a nephrolithotomy, how would you cut to enter the abdomen?
Ventral midline
What special instruments are used for a nephrolithotomy?
Rumel tourniquet, bulldog vascular clamp
T/F: For a nephrolithotomy, you want to make a sagittal incision into the kidney.
True
How can you close the kidney after a nephrolithotomy?
Sutureless - hold for 5 minutes -> fibrin seal (suture capsule)
Horizontal mattress
What is a pyelolithotomy?
Longitudinal incision into the renal pelvis to remove stones
What medication do you give to a patient after performing a nephrolithotomy?
Diuretic to maintain renal perfusion and minimize clot formation
How can you diagnose renal trauma?
Contrast excretory urography, exploratory celiotomy, ultrasound
How do you treat minor kidney trauma?
Conservatively
How do you treat moderate kidney trauma?
Surgical repair
How do you treat major kidney trauma?
partial nephrectomy, nephroureterectomy
What are the indications for a nephroureterectomy?
Severe infection or trauma, obstructive calculi with persistent hydronephrosis, neoplasia, transplant
How do you perform a nephroureterctomy?
Mobilize kidney, identify and ligate vessels, separate and ligate ureter at vesicoureteral junction
Why would you ever do a partial nephrectomy?
When you need to keep the function of the kidney, since the other kidney is fully damaged
How do you diagnose hydronephrosis?
Abdominal radiographs, excretory urogram, ultrasound
How long should hydronephrosis be in effect to have complete resolution?
Less than a week
How would you surgically treat hydronephrosis?
nephroureterectomy
What is pyelonephritis?
Inflammation of the renal pelvis, through complication with obstruction?
How do you treat advanced pyelonephritis?
nephroureterectomy
How do you treat giant kidney worm?
nephrectomy, nephrotomy
T/F: Renal neoplasia is usually benign.
False. MALIGNANT
What are some primary renal tumors?
Renal cell carcinoma, TCC, nephroblastoma
What are some metastatic renal tumors?
Lymphosarcoma, hemangiosarcoma, SCC
Which is the most common renal tumor in the dog?
Renal cell carcinoma
What is the mean survival time in dogs with renal cell carcinoma?
9 months
How do you treat renal cell carcinoma?
nephroureterectomy and chemotherapy
What is the most common neoplasia in the cat kidney?
Renal lymphoma
How long is the mean survival time for patients with embryonic nephroblastoma?
6 months
How do you diagnose renal neoplasia?
Palpation, radiographs, ultrasound, CT, MRI, urography
How would treat renal neoplasia?
Exploratory laparatomy, unilateral nephroureterectomy
What are some indications for performing a renal biopsy?
Suspected neoplasia, nephrotic syndrome, renal cortex disease, non-diagnosed ARF
What are some contraindications for performing a renal biopsy?
Coagulopathy, hypertension, severe chronic hydronephrosis
How much of the kidney do you want for collect for a biopsy?
> 5-6 glomeruli
What gauge needle range is typically used for a renal biopsy?
14-18 G
What are the techniques used for renal biopsy?
Percutaneous, ultrasound guided, keyhole, laparoscopic assisted
What is the most preferred method of renal biopsy?
Ultrasound guided
How do you close a wedge/incisional biopsy of the kidney?
Mattress suture
What are some potential complications with renal biopsies?
Severe hemorrhage, hematuria, hydronephrosis
What species are renal transplants performed on?
Cats
What are the indications for renal transplants?
Irreversible acute renal failure, decompensated chronic renal failure, polycystic disease
What suture material do you use for a renal transplant?
8/0 nylon
How long will patients with renal transplant need to be on immunosuppressants?
Lifelong
What is the means survival time of successful renal transplant patients?
1.5-2 years
613 days
What is the ureter’s function?
To transport urine
What other abnormalities are associated with ectopic ureter?
Hydroureter
Small/absent kidney
Pelvic Bladder
T/F: Cats commonly get ectopic ureters
False. RARE
What are some clinical signs of dogs with ectopic ureter?
Incontinence, poor house training, UTI, urine scalding
How do you diagnose ectopic ureter?
Excretory urography, CT, U/S, cystoscopy
What are the two classifications of ectopic ureter?
Extramural, intramural
What occurs with intramural ectopic ureters?
The ureter enters norally, but exits abnormally
What surgical procedures can you use to fix ectopic ureters?
Neoureterocystostomy (end-to-side and side-to-side), Laser transection of the wall
What are cystoscopic laser treatments for?
Intramural ureters
What 90% improvement happens with surgical correction of ectopic ureters, when given with medication?
90%
What medication do you give to patients after ectopic ureters, to control incontinence?
PPA
What is a ureterocele?
Dilation of distal ureter
If a ureterocele gets obstructed, what will you see?
Azotemia
How do you diagnose a ureterocele?
IV urography (see cobra head), ultrasound
How do you treat an intravesicular ureterocele?
Ureterocelectomy
How do you treat an ectopic ureterocele?
Neoureterocystotomy with ureterocelectomy
What is the #1 cause of ureteral trauma?
Iatrogenic
How would you diagnose ureteral trauma?
Uroretroperitoneum or a uroabdomen
How do you treat ureteral trauma?
Nephroureterctomy, ureteroureterostomy, neoureterocystostomy, urinary diversion
Which part of the ureter do you perform a ureteroureterostomy?
the proximal ureter
How is a ureteral stent used?
It is left proximal to the anastomosis of the ureter and extended down to the bladder via urethra
What is a nephrostomy tube for?
To divert urine after ureter surgery, hydronephrosis, or obstruction
What is the indication for a transureteroureterostomy?
When the proximal ureteral length is not long enough to reach the bladder, but can cross to the other side and attach to the other ureter
What are some ways to treat a loss in ureter length?
Renal Descensus, Nephrocystopexy distally, Psoas Hitch
What procedure is used if a significant amount of length is lost in the distal ureter?
Bladder wall flap
What is the most common indication for ureteral surgery?
Ureterolithiasis
T/F: Cats primarily have ureterolithiasis
True
How would you diagnose ureterolithiasis?
Radiographs, ultrasound
What are indications are needed for surgical treatment of urolithiasis?
Complete obstruction, azotemia, pyelonephritis, unsuccessful medical treatment
How long will it take to leave <65% of GFR left in an obstructed ureter?
1 week
T/F: Most cats have preexisting interstitial nephritis unrelated to obstruction
True
How do you treat urolithiasis?
Cystotomy and retrograde flushing and removal via pyelithotomy.
Ureterotomy
What are the advantages of a permanent ureteral stent?
Decrease the morbidity, shorter hospitalization, less complications
How do you perform a surgical stent on a dog?
Similar approach to a distal cystotomy
What is the SUB system?
Subcataneous ureteral bypass. Bypasses urine from kidney to ureter and goes straight from kidney to bladder
T/F: You cut the lateral ligaments during a cystotomy
False. Ventral ligament
Which nerve provides sympathetic innervation to the bladder?
Hypogastric nerve
Which nerve provides parasympathetic innervation to the bladder?
Pelvic nerve
What are the blood vessels for the bladder?
Caudal vesicular, prostatic/vaginal artery
What are some surgical diseases the bladder?
Ruptured bladder, cystic calculi, neoplasia, urinary incontinence
What is the urachus?
An embryonic channel that communicates the bladder and the allantoic sac
What is are the urachal abnormalities seen at birth?
Persistent urachus, vesicouracheal diverticulum, cyst, sinus
What signs will you see with persistent urachus?
Urine dribbling, omphalitis, ventral abdominal dermatitis, UTI
How can you diagnose and treat persistent urachus?
Place contrast medium in umbilicus, and surgically remove the tube
What happens with a vesicouracheal diverticulum?
An outpouching of the bladder from the atrophied urachus
How would you treat a vesicouracheal diverticulum?
Partial cystectomy and diverticulectomy
How would you treat a urachal cyst or sinus?
Surgical excision
What are some acute clinical signs of bladder rupture?
Hematuria, anuria, abdominal pain
What are some progression signs of bladder rupture?
dehydration, acidosis, azotemia, hyperkalemia, death in ~72 hours
T/F: In any trauma case, always assume bladder rupture until it is ruled out
True. Need to do radiographs or ultrasound
How do you diagnose a ruptured bladder?
Positive contrast urethrocystogram, abdominocentesis - urea in peritonium
How do you treat a ruptured bladder?
Immediate surgical repair, urinary diversion, exploratory laparotomy
When would you do a cystopexy?
For a tube cystostomy, perineal hernia, urinary incontinence
What do you connect the bladder to in a cystopexy?
Abdominal wall
How many lines of sutures are used in a cystopexy?
2
T/F: Tube cystostomies have high complication rates
True. Fistula formation, pet chewing, breaking, leakage
What is the most common bladder disease?
Ca oxalate cystic calculi
What are some clinical signs of cystic calculi disease?
thickened bladder, lower urinary tract syndromes
How can you diagnose cystic calculi?
Radiographs, pneumocystography, double contrast cystography, U/S
What are some non-surgical treatments for cystic calculi?
Hydropropulsion, transurethral cystoscopy, dietary modification, lithotripsy
What is the most common surgery of the bladder, and used to remove uroliths?
Cystotomy
T/F: Ventral cystotomy is the preferred method of surgery
True. You can visualize ureteral orifices
Where would you apply stay sutures for a cystotomy?
Lateral aspects and apex of the bladder
What is the least traumatic way to handle the bladder?
With stay sutures
What do you submit for culture and sensitivity on a cystotomy?
Urine, stones, mucosal tissues
What suture patterns should be used to close a cystotomy?
Cushing followed by Lembert, simple continuous of submucosa followed by cushing/lembert, double simple cutaneous appositional patterns
What tests can you do to check your cystotomy?
Leak test/compression, post-op radiographs
How quickly does it take for the bladder to heal after surgery?
2-3 weeks
What uncommon disease that is non-neoplastic, affects females, and resembles TCC, is confirmed through biopsy?
Polypoid cystitis
What is the most urinary tract tumor located in the dog?
Bladder
T/F: most bladder tumors are malignant
True
T/F: Bladder is the most common site for urinary tract tumors
False. Lymphoma is first
What are some predisposing factors for TCC?
Obesity, insecticide exposure, herbicide
How can you diagnose TCC?
Cytology, cystoscopy (very diagnostic), radiographs with or without positive contrast cystography, ultrasound
T/F: FNA is contraindicated in TCC
True. Avoid
Instead of an FNA, what can you use to get sample of a potential TCC?
Transurethral biopsy
What test is best used a routine screening for bladder tumor on older patients?
Bladder tumor antigen test
How would you treat a bladder tumor?
Partial cystectomy (>1 cm borders) with potential anastomosis of vessels, chemotherapy,
What is the mean survival time of after treatment of bladder tumors?
4-6 months
What are the surgical diseases associated with the urethra?
Strictures, obstructions, trauma, prolapse, incontinence, congenital
What are the surgical procedures used for the urethra?
urethrostomy, urethrotomy
T/F: In the male, the urethra is shorter and wider
False. Female is
What is the most common developmental abnormality of the male genitalia?
Hypospadias - incomplete formation of the penile urethra
What do you call the protrusion of the urethral mucosa through its orifice?
Urethral prolapse
What breed is most likely to get a urethral prolapse?
Young male brachycephalic dogs
What signs do you see with urethral prolapse?
Bleeding, licking, red mass
What are some ways to treat a mild urethral prolapse?
Purse string reduction, urethropexy folded into itself, or castration
How do you treat a severe urethral prolapse?
Resection and anastomosis using catheter and tourniquet
How fast does the urethral mucosa regenerate?
7 days
What potential problem with the urethra increases happens that increases surgical time and makes it difficult to identify tissue?
Edema
What suture material do you want to use for urethral surgery?
Monofilament absorbable (PDS, Maxon)
What suture material do you want to avoid?
Braided absorbable (Vicryl)
How can you diagnose urethral obstruction?
Radiographs, ultrasound, contrast urethrography
What are the goals when treating a urethral obstruction?
End with working kidneys, balance electrolytes, relieve obstruction, treat UTI, prevent reoccurrence
How would you perform a retrograde hydropropulsion?
Palpate the stone, compress the urethra, pass the catheter, pinch off orifice, inject saline, distend the urethra, relieve compression
What catheters can you use for a cat retrograde hydropropulsion?
tomcat catheter, slippery sam, red rubber catheter
What is often surgically performed to remove calculi in the urethra?
Cystotomy combined witha urethrotomy
Why would you perform a urethrostomy?
to prevent reoccurrence if medical prevention is not feasible
Where would incise for a urethrotomy in a dog?
Pre-scrotal
What muscle do you need to retract when performing a prescrotal urethrotomy?
retractor penis muscle
What suture material and size do you use to close a prescrotal urethrotomy?
4/0 or 5/0 monofilament absorbable (PDS)
When would you ever perform a perineal urethrotomy on a dog?
If the calculi is lodged between the scrotum and the ischial arch
When would you perform a urethrostomy?
Permanent damage to the urethra, recurrent obstruction, cannot remove obstruction
What location is preferred for dogs and cats, respectively?
Scrotal, perineal
What benefits does a scrotal urethrostomy have over other locations?
Less hemorrhage and urine scald
What should you also do to the dog when performing a scrotal urethrostomy?
Castrate
How would you suture a scrotal urethrostomy and why?
Laterally to prevent impingement on the urethra
How long is the urethra incision on a scrotal urethrostomy?
2.5-4 cm long or 5-8 times the urethral diameter
What suture material and size would you use for a scrotal urethrostomy?
4/0-5/0 monofilament. absorbable or non-absorbable works
When would you perform a urethrostomy with a cystotomy?
When stones are in the ischial arch
What are some complications with a scrotal urethrostomy?
hemorrhage, dehiscence, urine scald, stricture, UTI
Why is a prescrotal urethrostomy worse than a scrotal?
Has a higher incidence of urine scald
When would you perform a perineal urethrostomy on a dog?
Only when a more distal approach is not possible
A perineal urethrostomy is considered a ______ procedure to treat FLUTDS and calculi in _____ cats.
salvage; male
What are the indications for performing a perineal urethrostomy in a cat?
frequent obstructions, strictures, trauma
What do you need to do to the anus before opening the perineum for a perineal urethrostomy?
Anal purse string
What shape incision do you create around the scrotum and prepuce in a perineal urethrostomy?
Elliptical
What tissue forceps do you use for traction at the end of the prepuce in a perineal urethrostomy of a cat?
Allis tissue forceps
What muscles are cut from the penis in a perineal urethrostomy?
ischiocavernosus and ischiourethralis and retractor penis muscle
What suture do you use for a perineal urethrostomy when connecting the urethral mucosa to the skin?
5/0 monofilament
How often do complications with perineal urethrostomies occur?
25%
If stricture occurs after a perineal urethrostomy, what caused it?
Poor surgical technique
What do you do if after a perineal urethrostomy, you notice subcutaneous urine?
catheterize for 5-7 days
When would you perform an antepubic urethrostomy?
If the perineal urethrostomy failed and cannot be fixed
