Kidney & Ureter Sx

Question 1

Obj: Understand surgical procedures and when they are indicated

Question 2

Obj: Know the surgical options for ureteral obstruction

Question 3

Obj: Know the clinical signs, diagnosis, and treatment of ectopic ureters

Question 4

What are some indications for Kidney/Ureter surgery?

Answer 4

• Tumors
• Hydronephrosis
• Abscess
• Ectopic ureters
• Urolithiasis
• Biopsy
• Trauma

Question 5

What are the preoperative considerations for kidney/ureter surgery?

Answer 5

• Clinical signs, physical exam
• CBC, Serum chemistry, UA
• Blood pressure
• Abdominal Radiographs
• Abdominal ultrasound
• Renal function?
• Ensure proper pre-op hydration

Question 6

What surgical approach is used in kidney/ureter surgery

Answer 6

• Ventral Midline approach
  
  • Xiphoid to pubis

Question 7

What surgical procedures involving the kidney/ureter are commonly done?

Answer 7

• Nephroureterectomy/nephrectomy
  
  • Complete - most common
  • Partial - Rare
• Biopsy
• Renal Transplantation
• Ureteral surgery

Question 8

What is a Nephrectomy? When is it indicated?

Answer 8

• Complete removal of kidney and associated ureter
• Indications:
  
  • Neoplasia
    
    • <2% of all canine cancer
    • Renal Carcinoma - Dog
    • Lymphoma - Cat (non surgical)
  • Severe hydronephrosis
    
    • Secondary to ureteral obstruction
    • Dilation of renal pelvis
    • Atrophy of renal parenchyma
  • Abscess/pyelonephritis
    
    • Rare - associated with pyelonephritis, nephrolithiasis
  • Trauma - extremely rare

Question 9

What are the general steps to a nephrectomy?

Answer 9

1. Free attachments bluntly
2. Rotate kidney medially
3. Ligate vessels
   
   1. multiple renal arteries
      
      1. 13% dogs
      2. 10% cats
      3. Left> right
4. Ligate and transect ureter at level of bladder

Question 10

What are the indications for Ureteral surgery?

Answer 10

• Ectopic ureters
• Ureterolithiasis
• ureteral trauma

Question 11

What is an Ectopic Ureter? signs?

Answer 11

• Congenital
• Abnormal location of ureteral openings distal to the trigone
• Sign: urinary incontinence since weaning

Question 12

which animal/sex is more commonly affected by ectopic ureters?

Answer 12

• Dogs >>> cats
• Females >>> males (20:1)

Question 13

What are the different types of ectopic ureters?

Answer 13

• Intramural:
  
  • ureter tunnels in wall of bladder and has abnormal location of opening distal to trigone
• Extramural:
  
  • ureter enters bladder at abnormal location distal to trigone without tunneling in bladder wall

Question 14

How are ectopic ureters diagnosed?

Answer 14

• Rule out UTI, urolithiasis
• Abdominal ultrasound
  
  • Concurrent abnormalities
• Cystoscopy
• CT scan
• Excretory urogram
• consider urethral pressure profilometry

Question 15

How are ectopic ureters repaired?

Answer 15

• Intramural:
  
  • Neoureterostomy
  • Cystoscopic laser treatment
• Extramural:
  
  • Ureteroneocystostomy

Question 16

What surgical complications are common to ectopic ureter repair?

Answer 16

• Stricture ⇢ hydronephrosis
• Incontinence resolved in 22-59% of patients
  
  • additional 7-28% improved w/ medical management
  • Surgery + medical management 50-75%

Question 17

What is a ureterotomy?

Answer 17

• Incising into the ureter

Question 18

What are the potential complications of a ureterolith

Answer 18

• Hydroureter & hydronephrosis
  
  • loss of renal function

Question 19

How is the incision for a ureterotomy repaired?

Answer 19

• 5-0 to 7-0 simple interrupted suture

Question 20

What are the potential complications of ureterotomy?

Answer 20

• Leakage
• Stricture Formation
• inability to locate and/or remove all stones

Question 21

What are the treatments for ureterolithiasis?

Answer 21

• Ureterotomy
• Subcutaneous ureteral bypass (SUB) system - cats
• Ureteral stenting - dogs

Question 22

How are SUBs cared for?

Answer 22

• Flushing every 3-6 mo w/ ultrasound evaluation
  
  • Lifelong commitment
• urine culture performed at every flush
• Management of chronic kidney disease