SASx Final Exam - Urinary System Flashcards
How do you diagnose vesicourachal diverticulum?
Positive contrast cystography
T/F: Perineal urethrostomy is successful in preventing LUT disease in cats
False
Perineal urethro_st_omy is a salvage procedure to treat FLUTDS and calculi in male cats. It increases incidence of bacterial cystitis and does not prevent FLUTDS
-
Indications for perineal urethro_st_omy in cats:
- Frequent obstructions
- Strictures
- Trauma
T/F: Urine cytology is useful for diagnosing transitional cell carcinoma (TCC)
True
30% will exfoliate cells
T/F: Even if hydronephrosis is caught late (> 4 weeks), the kidneys will likely be able to regain at least 75% function
False
If caught >4 weeks, you will be lucky to MAYBE regain 25% function
With regard to urethral surgery:
- Urine diversion (increases/decreases) inflammation.
- Catheterization (increases/decreases) inflammation.
Urine diversion decreases inflammation. Catheterization increases inflammation
What is the most common surgery performed on the urinary bladder and what are its indications?
cystotomy
- Most common surgery of the bladder
- Most common procedure for urolith removal
-
Indications:
- Urinary tract obstructions
- No medical options
- Other retreival methods have failed
What is the most common cause of ureteral trauma?
ovariohysterectomy!
T/F: Second intention healing of the urethra is the preferred method of closure for a prescrotal urethrotomy
True
- less risk of stricture and fewer complications associated with suturing the small urethral lumen*
- The down side to second intention healing is that your patient is likely to have profuse hemorrhage from the area, so they will need to be hospitalized for a few days*
What is the most common renal neoplasia seen in felines?
renal lymphoma
- Most common renal neoplasia in the cat
- MST depends on stage
- Surgery may not be indicated
T/F: Radiography is helpful for diagnosing calcium oxalate, cystine, and urate stones in the bladder
False
Cystine and urates are radiolucent!
What is the composition of more than 40% of nephroliths?
Calcium Oxalate (CaOx)
T/F: You can easily rule out bladder rupture by palpation. If the bladder is palpable, rupture is not present
False
-
In any trauma case, consider bladder rupture until you can rule it out
- Palpable bladder does not rule out
- Normal urination does not rule out
- Urine retrieval by catheter does not rule out
What surgery is being performed in this image?
partial nephrectomy
- Not often performed; technically more difficult than full nephrectomy
- Preserves renal function, but higher incidence of post-op hemorrhage
- Surgical steps:
- Occlude blood supply, Incise and peel back capsule, Pass suture with straight needle, Divide in thirds, Tighten sutures, Loosen tourniquet, Close capsule
What is the most common benign neoplasia seen in the kidneys?
renal adenoma
When closing the urinary bladder, serosa to serosa contact encourages __________, which helps ensure a water tight closure
fibrin seal
When closing the urinary bladder, serosa to serosa contact encourages fibrin seal, which helps ensure a water tight closure
T/F: Pyelonephritis is an indication for removal of the kidney
True
Where does the urinary bladder receive its nerve supply?
hypogastric n. (sympathetic) and pelvic n. (parasympathetic)
What is the most common urethrostomy site in cats?
perineal
________ urethrotomy is indicated for calculi lodged between scrotum and ischial arch
perineal urethrotomy
perineal urethrotomy is indicated for calculi lodged between scrotum and ischial arch
-
Try to avoid in dogs if possible
- Difficult procedure (urethra deeper)
- Increase risk of infection
- Usually suture urethrotomy incision
T/F: One or two layer closure is acceptable for closure of the urinary bladder
True
What is the most common urethrostomy site in dogs?
scrotal
If you suspect cystic calculi in your patient but you’re unable to view any stones on radiographs, what other diagnostic modalities are useful?
pneumocystography, double contrast cystography, ultrasound
All three are about equally effective in detecting radiolucent stones
In male cats, urethral obstruction is most often caused by:
mucus plug/crystals
Occurs most commonly in the distal 1/3 of the urethra in male cats
What size suture is typically used for closure of the urinary bladder?
3-0
Options include PDS, Monocyl, Vicryl, Dexon, Prolene, Nylon
Where is a urethrotomy typically performed in our canine patients?
prescrotal area
just caudal to the caudal aspect of the os penis (between the scrotum and the os penis)
- Very superficial area
- Less cavernous tissue
- incision is made right over the urethra
What are the indications for performing a cystopexy?
- Tube cystotomy
- Perineal hernia
- Urinary incontinence associated with pelvic bladder
When performing a prescrotal urethrotomy: after you’ve made the incision on the ventral midline, you want to isolate the __________ muscle and deviate it laterally to gain access to the prescrotal urethra
retractor penis muscle
- When performing a prescrotal urethrotomy: after you’ve made the incision on the ventral midline, you want to isolate the retractor penis muscle muscle and deviate it laterally to gain access to the prescrotal urethra*
- Once you have access, you’ll make an incision into the urethra to find the stone*
If your patient has a non-functional kidney or severe parenchymal damage, what is the surgical treatment of choice?
Nephroureterectomy
- (Surgical removal of the kidney and its ureter)*
- Neff-row-your-eat-er-ek-to-mee*
What is the treatment option for ectopic ureterocele?
Neoureterocystostomy with ureterocelectomy
knee-yo-your-eat-er-oh-sis-tossed-to-me with your-eat-er-oh-sell-ek-to-me
Progressive dilatation of the renal pelvis and atrophy of the renal parenchyma is termed:
hydronephrosis
What is the treatment of choice for persistent urachus?
surgical removal of the urachal tube
T/F: Surgical correction of the airways may be indicated in cases of urethral prolapse
True
Especially in brachycephalic breeds, this condition may be worsened by straining to breath
The urinary bladder is attached by ligaments. Which of those ligaments should be avoided during surgery?
lateral ligaments
The lateral ligaments contain the distal ureters.
What procedure is being performed here?
retrograde hydropulsion
This is performed in canine patients only!
T/F: Perineal urethrostomy is the preferred approach in the dog?
False
Only indicated when a more distal approach is not possible (tissue damaged or not possible)
Between dorsal cystotomy and ventral cystotomy, which one is preferred?
ventral approach is preferred
Increased exposure of the bladder neck, can visualize ureteral orifices
T/F: There is a very high incidence of urethral obstruction in female cats with LUTD
False
There is a very high incidence of urethral obstruction in _male cats with LUTD_
T/F: In the case of bladder rupture in a metabolically unstable animal, IV fluids are indicated
True
- Patients with bladder rupture should always be stabilized prior to surgery! It sounds counter-intuitive, but you want to give them fluids to help correct acid-base status, electrolytes, etc.*
- Often times the clinician will perform an abdominocentesis as they are giving fluids to allow the fluid to drain*