Surgery Of The Bladder Flashcards
What are the types of urachal abnormalities?
Persistent urachus
Vesicocuracheal diverticulum
Urachal cyst (rare)
Urachal sinus (rare)
Clinical signs of a persistant urachus?
Urine dribbling from umbilicus
Omphalitis
Ventral abdominal dermatitis (urine scald)
UTI
How can you confirm a diagnosis of persistent urachus?
Place contrast in umbilicus —> bladder
Treatment of persistent urachus?
Surgical removal of urachal tube —> dissect urachus from umbilicus and excise urachus at apex of bladder
What is a vesicourachal diverticulum ?
External opening of urachus is closed but bladder attachment is patent
Vesicourachal diverticulum predisposes patient to??
Uroliths and UTI
How can you diagnose vesicourachal diverticulum?
Positive contrast cystography
Surgical treatment for vesicourachal diverticulum ?
Partial cystectomy and diverticulectomy
What is a urachal sinus?
Persistent distal urachus remains open -> omphalitis (surgically excise)
Etiology of bladder rupture?
Trauma Cystitis Neoplasia Urethral obstrucion Iatrogenic -cystocentesis -catheterizaiton -manual expression -dehiscence after surgery
** often difficult to repair because of bruising and stretching
Clinical signs of bladder rupture?
Acute —> Hematuria, anuria, abdominal pain
Progression of clinical signs —> dehydration, acidosis, azotemia, hyperkalemia
What are important considerations before you rule out bladder rupture??
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 can you diagnose/ rule out bladder rupture?
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
What is the most reliable way to diagnose bladder rupture?
Positive contrast urethrocystogram
- > leakage of contrast material in abdomen
- > highlights intestinal loops
Treatment for bladder rupture ?
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)
When do you do tube cystostomy?
Need for urinary diversion
-> stabilize patient with LUT obstruction
- > bladder or urethral trauma or surgery
- > neurologic bladders (long term)
Requires cystopexy
What are indications for cystopexy?
Tube cysostomy
Perineal hernia
Urinary inconvenience associated with pelvic bladder
When doing a cystopexy you are attaching the bladder to the??
Abdominal wall —> crainial traction with two lines of sutures
How do you do a tube cysostomy??
Ventral midline incision
Purse string suture
Stab incision
6-16fr Foley or mushroom tip
Perform cystopexy
Closed system
What are complications of tube cystotomy?
Inadvertent tube removal Pet chewing on tube Breakage of mushroom tip Fistula formation after removal Urine leakage around tube
Diagnosis for cystic calculi?
Radiographs -> struvite and Ca are radio-opaque
Pnumocytography —> air injected into bladder and provide radiolucent contrast media
Double contrast cystography
U/S
Non-surgical treatment of cystic calculi?
Urohydropropulsion
Dietary
Cytoscopy with baskets
Electro hydraulic lithotripsy
Indications for cystotomy?
Urinary tract obstruction
-none/other medical treatments have failed
What is the preferred approach to cystotomy? Why?
Ventral approach
- increased exposure of the bladder neck and can visualize ureteral offices
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
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
What is the layer of strength in the bladder?
Submucosa
When closing the bladder _______ to _____ contact encourages a fibrin seal
Serosa to serosa
What are possible suture options for closure of the bladder?
Absorbable
- > PDS
- > Monocyl
- > vicryl (braided)
- > dexon (coated, braided)
Non-absorbable
- > nylon
- > prolene
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 *
What appositional pattern can be used to close the bladder?
Simple continuous in submucosa followed by simple continuous in seromuscular larger
What non-neoplasic process occurs in females, affects the mucosal and resembles TCC?
Polyploid cystitis
What can you use to help diagnose polyploid cystitis?
US, cystoscope
Biopsy
Most common location and type of tumor in the bladder of dogs?
TCC -97% malignant
Trigone
Signalment for canine bladder tumors
Scottish terriers
Older females
Feline bladder tumors are usually found in what site of the bladder?
Apex
Signalment for feline bladder tumors
Middle aged males
Predisposing factors to TCC?
Obesity
Insecticide exposure
Herbicide
Cyclophosphamide
Diagnosis of TCC?
PE
—> abdominal palpation
—> lameness/cough
Radiograph
-> positive contrast
US
- > evaluate LN
- > avoid FNA tumor seeding
Transurethral biopsy
BTAT —> high false positive
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
