Surgery Of The Ureters Flashcards
What are surgical diseases of the ureters?
Ureter ectopica
Ureterocele
Trauma
Obstrucion
What are common associated abnormalities associated with ectopic ureters?
Hydroureter
Small/absent kidney
Pelvic bladder
Breeds predisposed to ectopic ureters?
Siberian husked
Labrador/golden retrievers
West highland terreris
Females> males
Young
Rare in cats
Clinical signs associated with ectopic ureters?
Incontinence
Fails to house train
UTI
Urine scalding
What are the best ways to diagnose ectopic ureters?
Excretory urography
- > pneumocytography
- > fluoroscopy
CT
Ultrasound
Cytoscopy
What are the two classifications of ectopic ureters?
Extramural —> less common, enters into neck urethra, or vagina
Intramural —> enters normally but exits abnormally (most common in dogs)
Cystoscopic laser treatment can be used on what type of ectopic ureter?
Intramural
-> abalation of the ureter from the desired opening to the actual
What is the prognosis for ectopic ureters?
Incontinence improves in 60%
90% improvement when medications added (PPA- phenylpropanolamine )
What surgical technique can be used for either extramural or intramural ectopic ureters?
Neoureterocystostomy
-> create new opening for ureter in bladder and suture to bladder wall
What is a ureterocele?
Dilation of distal ureter
Persistent membrane in embryonic development
Clinical signs associated with ureterocele ?
UTI, incontinence
Azotemia if obstructed
How does a ureterocele appear with IV ureogrpay?
Cobra head sign
See ureter entering bladder with enlarged ball in the bladder
Treatment for an intervesicular ureterocele ?
ureterocelectomy
Treatment for an ectopic ureterocele?
Neoureterocystostomy with ureterocelectomy
What is the number one cause of ureteral trauma?
Iatrogenic - during spay
Other causes
-blunt trauma or obstruction
How can ureteral trauma be diagnosed?
Presence of uroretroperitoneum or uroabdomen
Radiographs
IV urograph - localized lesion
What are the possible treatments for ureteral trauma?
Nephroureterectomy (if financial constraints, and minimizes complications)
Ureteroureterostomy (ureteral anastomoses)
Neoureterocystostomy (ureteral reimplanation)
Urinary diversion
What is the procedure of choice for a case of ureteral trauma where there is poor function in the contralateral kidney and the injury is of the proximal part of ureter?
Cannot reimplant this ureter into bladder
Ureteroureterostomy —> anastomoses
Catheterize through cystotomy
—> avoids back wall getting caught in suture
—> angle cut ends
Catheter is left proximal to the anastomoses and extends down through the bladder and urethra
—> catheter is removed in 5-7days
When is a nephrostomy tube used? How is it placed?
To divert urine after ueter surgery, hydronephrosis, or obstruction
Fenestrated tube passed through kidney to renal pelvis
Place tube outside patient
Anchor kidney
Closed system
What technique is used when proximal urethral length is insufficient to reach the bladder but is long enough to cross midline?
Trans ureteroureterostomy
—> distal ureter is brought across midline and anastomosed to the other ureter
What surgical techniques can you use if you have loss of ureter length?
Renal decensus —> mobilize kidney and sutures caudally to lumbar musculature
Nephrocystopexy —> suture the kidney to the cranial edge of bladder
Psoas hitch —> fix bladder in a more cranial position
When is a bladder wall flap used?
Significant loss of distal ureter
How is a bladder wall flap made?
Rectangular bladder wall section cut on 3/4 sides
—> flap elevated ureter is implanted into end of flap wall and opening sutured into flap wall
Suture flap into a tube and close defect
What is the most common indications for ureteral surgery?
Ureterolithiasis
Clinical signs of ureterolithaiasis ?
Asymptomatic (unilateral)
UTI
Hematuria
Anorexia, lethargy
Pain
T/F: IV fluids are indicated in cases with Ca oxalate ureterolithiasis?
True
-help increase flow
What are indications for lithotripsy of the ureters?
Complete obstruction
Azotemia
Pyelonephritis
After 2 weeks of unsuccessful medical treatment
If you have a unilateral ureteral obstrucion but your animal has an azotemia, what does this indicate?
Bilateral renal disease
Most cats have preexisting __________ which is unrelated to obstruction
Interstitial nephritis
What are possible treatments for ureterolithiasis?
Cystotomy and retrograde flushing follow by removal via pyelithotomy (try this first)
Ureterotomy —> longitudinal incision —> lavage ureter —> transverse or longitudinal closure —> nephrostomy drainage
What are the advantage to permanent ureteral stenting??
Decreased morbidity
Shorter hospitalization
Less complications
Indications for permanent ureteral stenting?
Stone
Tumor
Stricture
Blood clot
