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RUSVM Small Animal Surgery 1 > Surgery Of The Bladder > Flashcards

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)

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2
Q

Clinical signs of a persistant urachus?

A

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

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3
Q

How can you confirm a diagnosis of persistent urachus?

A

Place contrast in umbilicus —> bladder

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4
Q

Treatment of persistent urachus?

A

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

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5
Q

What is a vesicourachal diverticulum ?

A

External opening of urachus is closed but bladder attachment is patent

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6
Q

Vesicourachal diverticulum predisposes patient to??

A

Uroliths and UTI

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7
Q

How can you diagnose vesicourachal diverticulum?

A

Positive contrast cystography

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8
Q

Surgical treatment for vesicourachal diverticulum ?

A

Partial cystectomy and diverticulectomy

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9
Q

What is a urachal sinus?

A

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

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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

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11
Q

Clinical signs of bladder rupture?

A

Acute —> Hematuria, anuria, abdominal pain

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

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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

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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

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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
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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)
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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

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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
Q

T/F: the ventral and lateral ligaments of the bladder can be removed if they are in your way

A

FALSE !!!

NEVER TOUCH THE LATERAL LIGAMENT —> ureters in here

Can remove the ventral ligament

26
Q

How would you perform a cystotomy?

A

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
Q

What is the layer of strength in the bladder?

A

Submucosa

28
Q

When closing the bladder _______ to _____ contact encourages a fibrin seal

A

Serosa to serosa

29
Q

What are possible suture options for closure of the bladder?

A

Absorbable

  • > PDS
  • > Monocyl
  • > vicryl (braided)
  • > dexon (coated, braided)

Non-absorbable

  • > nylon
  • > prolene
30
Q

What inverting patterns can be used for the bladder?

A

Cushing followed by lambert

Simple continuous in submucosa followed by cushing pattern

  • remember inverting patterns decreased volume of bladder *
31
Q

What appositional pattern can be used to close the bladder?

A

Simple continuous in submucosa followed by simple continuous in seromuscular larger

32
Q

What non-neoplasic process occurs in females, affects the mucosal and resembles TCC?

A

Polyploid cystitis

33
Q

What can you use to help diagnose polyploid cystitis?

A

US, cystoscope

Biopsy

34
Q

Most common location and type of tumor in the bladder of dogs?

A

TCC -97% malignant

Trigone

35
Q

Signalment for canine bladder tumors

A

Scottish terriers

Older females

36
Q

Feline bladder tumors are usually found in what site of the bladder?

A

Apex

37
Q

Signalment for feline bladder tumors

A

Middle aged males

38
Q

Predisposing factors to TCC?

A

Obesity
Insecticide exposure
Herbicide
Cyclophosphamide

39
Q

Diagnosis of TCC?

A

PE
—> abdominal palpation
—> lameness/cough

Radiograph
-> positive contrast

US

  • > evaluate LN
  • > avoid FNA tumor seeding

Transurethral biopsy
BTAT —> high false positive

40
Q

Treatment for TCC?

A

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

RUSVM Small Animal Surgery 1 (39 decks)

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