Surgery of the urinary tract

Question 1

Indications for renal surgery (i.e. what are the surgeries?)

Answer 1

• nephrectomy
• renal biopsy
• nephrotomy

Question 2

Prerequisite for nephrectomy

Answer 2

• normal function of the contralateral kidney

Question 3

Contraindication for nephrectomy

Answer 3

• azotaemia or persistent isosthenuria

Question 4

Indications for nephrectomy

Answer 4

• Renal and ureteral neoplasia
• Trauma
• Persistent renal haematuria
• Polynephritis associated with polycystic disease
• End-stage hydronephrosis
• Single renal cysts associated with renal disease
• Renal or perirenal abscessation
• Chronic end-stage pyelonephritis
• Renal disease associated with ectopic ureter

Question 5

Indications for renal biopsy

Answer 5

• Investigation of proteinuric renal disease
• Renomegaly (or renal mass)
• Familial renal disease
• renal amyloidosis
• renal dysplasia
• polycystic kidneys
• basement membrane disorders
• tubular dysfunction (Fanconi’s syndrome)
• Acute renal failure

Question 6

Indications for nephrotomy

Answer 6

• removal of renal calculi

Question 7

Complications of renal surgery

Answer 7

• Renal pain
• Haemorrhage
• Haemoabdomen
• Haematuria
• Retroperitoneal and peritoneal
  urine leakage (uroabdomen)
• UTI
• Compromise of renal function
  (renal failure)

Question 8

Indications for cystotomy

Answer 8

• calculi (urolithiasis)
• biopsy
• tumour removal
• ureteral ectopia

Question 9

Cystotomy closure: suture material & size

Answer 9

• Absorbable monofilament (e.g., polydioxanone, polyglyconate, poliglecaprone,
  glycomer 631)
• Size
• 4/0 or 3/0 cats
• 4/0, 3/0 or 2/0 dogs

Question 10

Cystotomy closure: pattern

Answer 10

• One-layer: full thickness (simple
  interrupted, simple continuous, continuous
  inverting (e.g., Connell, Cushing, Lembert)
• Two-layer
• Submucosal / mucosa
• Seromuscular

Question 11

Cystotomy closure: other considerations

Answer 11

• use an atraumatic needle
• drape omentalisation of site of repair
• single layer continuous appositional closure +/- second layer of inverting suture if concerned about leakage in thin walled bladder

Question 12

Indications for partial cystectomy

Answer 12

• Discrete, operable neoplasia
• Discrete, localised nidus of infection
• persistent urachal remnant with infection

Question 13

Complications of urinary bladder surgery

Answer 13

• Haemorrhage
• Haematuria
• Haemoabdomen
• Peritoneal urine leakage (uroabdomen)
• UTI (cystitis)
• Urothelial oedema
• Dysuria
• Small bladder volume
• Reflex dyssynergia

Question 14

What is reflex dyssynergia?

Answer 14

• results in urine retention associated with increased outflow resistance during attempts to void due to failure o the alpha-adrenergic input to the internal urethral sphincter to be reflexly inhibited
• i.e. functional obstruction

Question 15

Indications for tube cystotomy

Answer 15

Urinary diversion in animals with either:
- Functional or mechanical obstruction of the bladder or urethra
- Excessive urine retention (atonic bladder)
- Post bladder / urethral surgery (urinary
bypass)