Surgery Of The Bladder Flashcards

1
Q

What are the types of urachal abnormalities?

A

Persistent urachus
Vesicocuracheal diverticulum
Urachal cyst (rare)
Urachal sinus (rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical signs of a persistant urachus?

A

Urine dribbling from umbilicus
Omphalitis
Ventral abdominal dermatitis (urine scald)
UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can you confirm a diagnosis of persistent urachus?

A

Place contrast in umbilicus —> bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatment of persistent urachus?

A

Surgical removal of urachal tube —> dissect urachus from umbilicus and excise urachus at apex of bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a vesicourachal diverticulum ?

A

External opening of urachus is closed but bladder attachment is patent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Vesicourachal diverticulum predisposes patient to??

A

Uroliths and UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can you diagnose vesicourachal diverticulum?

A

Positive contrast cystography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Surgical treatment for vesicourachal diverticulum ?

A

Partial cystectomy and diverticulectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a urachal sinus?

A

Persistent distal urachus remains open -> omphalitis (surgically excise)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Etiology of bladder rupture?

A
Trauma 
Cystitis 
Neoplasia 
Urethral obstrucion 
Iatrogenic 
-cystocentesis 
-catheterizaiton 
-manual expression 
-dehiscence after surgery 

** often difficult to repair because of bruising and stretching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical signs of bladder rupture?

A

Acute —> Hematuria, anuria, abdominal pain

Progression of clinical signs —> dehydration, acidosis, azotemia, hyperkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are important considerations before you rule out bladder rupture??

A

Any trauma case you should consider rupture until you can R/O

Palpable badder does not R/O
Normal urination does not R/O
Urine retrieval by catheter does not R/O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can you diagnose/ rule out bladder rupture?

A

Radiographs
—> abdominal fluid
—> Absence of bladder
—> decreased serosal detail

US 
—> free fluid 
—> concurrent injuries 
—> guide for abdominocentesis 
—> helps determine source of injury 

Positive contrast urethrocytogram
Abdominocentesis : creat abdominal fluid > serum creat AND high potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most reliable way to diagnose bladder rupture?

A

Positive contrast urethrocystogram

  • > leakage of contrast material in abdomen
  • > highlights intestinal loops
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment for bladder rupture ?

A

Fluid and abdominocentesis to stabilize

Urinary diversion —> catheter or tube cystotomy

Surgery 
—> exploratory laparotomy 
—>debridement torn and necrotic tissue 
—> Close bladder wall 
—> omentalize or serosal patching 
—> catheterize urethra (keep bladder empty)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do you do tube cystostomy?

A

Need for urinary diversion
-> stabilize patient with LUT obstruction

  • > bladder or urethral trauma or surgery
  • > neurologic bladders (long term)

Requires cystopexy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are indications for cystopexy?

A

Tube cysostomy
Perineal hernia
Urinary inconvenience associated with pelvic bladder

18
Q

When doing a cystopexy you are attaching the bladder to the??

A

Abdominal wall —> crainial traction with two lines of sutures

19
Q

How do you do a tube cysostomy??

A

Ventral midline incision
Purse string suture
Stab incision

6-16fr Foley or mushroom tip

Perform cystopexy

Closed system

20
Q

What are complications of tube cystotomy?

A
Inadvertent tube removal 
Pet chewing on tube 
Breakage of mushroom tip 
Fistula formation after removal 
Urine leakage around tube
21
Q

Diagnosis for cystic calculi?

A

Radiographs -> struvite and Ca are radio-opaque

Pnumocytography —> air injected into bladder and provide radiolucent contrast media

Double contrast cystography

U/S

22
Q

Non-surgical treatment of cystic calculi?

A

Urohydropropulsion
Dietary
Cytoscopy with baskets
Electro hydraulic lithotripsy

23
Q

Indications for cystotomy?

A

Urinary tract obstruction

-none/other medical treatments have failed

24
Q

What is the preferred approach to cystotomy? Why?

A

Ventral approach

  • increased exposure of the bladder neck and can visualize ureteral offices
25
T/F: the ventral and lateral ligaments of the bladder can be removed if they are in your way
FALSE !!! NEVER TOUCH THE LATERAL LIGAMENT —> ureters in here Can remove the ventral ligament
26
How would you perform a cystotomy?
Caudal ventral midline approach Moistened lap sponge - Empty bladder —> compression/ small needle and syringe Males drape prepuce in field Stay sutures at apex and lateral —> avoid tissue handling Stab incision at apex and extend with scissors Evert walls, remove calculi Pass urethral catheter and flush -> patency Submit urine, stones, and mucosal tissue for C/S
27
What is the layer of strength in the bladder?
Submucosa
28
When closing the bladder _______ to _____ contact encourages a fibrin seal
Serosa to serosa
29
What are possible suture options for closure of the bladder?
Absorbable - >PDS - > Monocyl - > vicryl (braided) - > dexon (coated, braided) Non-absorbable - > nylon - > prolene
30
What inverting patterns can be used for the bladder?
Cushing followed by lambert Simple continuous in submucosa followed by cushing pattern * remember inverting patterns decreased volume of bladder *
31
What appositional pattern can be used to close the bladder?
Simple continuous in submucosa followed by simple continuous in seromuscular larger
32
What non-neoplasic process occurs in females, affects the mucosal and resembles TCC?
Polyploid cystitis
33
What can you use to help diagnose polyploid cystitis?
US, cystoscope | Biopsy
34
Most common location and type of tumor in the bladder of dogs?
TCC -97% malignant | Trigone
35
Signalment for canine bladder tumors
Scottish terriers | Older females
36
Feline bladder tumors are usually found in what site of the bladder?
Apex
37
Signalment for feline bladder tumors
Middle aged males
38
Predisposing factors to TCC?
Obesity Insecticide exposure Herbicide Cyclophosphamide
39
Diagnosis of TCC?
PE —> abdominal palpation —> lameness/cough Radiograph -> positive contrast US - > evaluate LN - > **avoid FNA** tumor seeding Transurethral biopsy BTAT —> high false positive
40
Treatment for TCC?
Partial cystectomy with >1cm borders (tumor seeding) Often involves trigone (salvage procedure) —> ureterocolonic anastomosis —> ureterouterine anastomosis Chemo —> piroxican, cisplatin, mitoxantrone Mean survival time - 4-6months with treatment