surgery of the urinary tract Flashcards
What are the prerequisites and contraindications for performing a nephrectomy?
- Normal function of the contralateral kidney is a prerequisite for performing nephrectomy
- The presence of azotaemia or persistent isosthenuria is a contraindication for nephrectomy
What are the indication for nephrectomy?
- 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
what are the indication for renal biopsy?
what are the issues with biopsy?
what are the two types of renal biopsy?
- 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
Don’t do this very often as getting a name for disease doesn’t actually change the treatment - therefore no point, and the biopsy will worsen the kidney disease
**Wedge biopsy ** - bad idea - have to remove the kidney from the circulation (clamps or ligature) and then suture up the kidney - which doesn’t take suture very will
Punch biopsy - better idea
what is the indication for nephrotomy?
How is it done?
- Removal of renal calculi
- cut pole to pole on the lateral side
- remove calculi
- suture up the kideny - sutures don’t hold well
- have to take the kidney out of circulation
How is a Nephrectomy performed?
- ventral midline incision,
- cut through peritoneum
- flip the kidney over to work form the dorsal surface - better visual
what are the complication of renal surgery?
- Renal pain
- Haemorrhage
◦ Haemoabdomen
◦ Haematuria - Retroperitoneal and peritoneal urine leakage (uroabdomen)
- Urinary tract infection
- Compromise of renal function (renal failure)
what are the reasons for cystotomy?
How is it performed?
what sutures are used?
Reason:
* Calculi (urolithiasis)
* Biopsy
* Tumour
* Ureteral ectopia
Place stay sutures - one at the pole and then two laterally
Place incision - on the ventral wall, from pole to neck
* if you want to take biopsy then take the edge of the incision
* suture holding layer is submucosa
Don’t manhandle the mucosal surface (urothelium) of the bladder, will become oedematous, will be unable to urinate
Suture:
* Absorbable monofilament (e.g., polydioxanone, polyglyconate, poliglecaprone, glycomer 631)
* wound support for 10-14 days
Size
* 4/0 or 3/0 cats
* 4/0, 3/0 or 2/0 dogs
Pattern
* One-layer – full thickness (simple interrupted, simple continuous, continuous inverting (e.g., Connell, Cushing, Lembert)
- No consistent agreement on best suture pattern – classically, the bladder was closed in two-layers
- Single layer continuous appositional closure +/- second layer of inverting suture if concerned about leakage in thin walled bladder
- Use an atraumatic needle
- Drape omentalisation of the site of repair
when is a partial cystectomy used?
what is the complication?
- Discrete, operable neoplasia
- Discrete, localised nidus of infection
◦ persistent urachal remnant with infection
bladder is made smaller - but in the early days will urinate more frequently (precipitant urination)
what are the complication of urinary bladder surgery?
- Haemorrhage
◦ Haematuria
◦ Haemoabdomen - Peritoneal urine leakage (uroabdomen)
- Urinary tract infection (cystitis)
- Urothelial oedema
- Dysuria
- Small bladder volume
- Reflex dyssynergia
when are tube cystomomy used?
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)
how are dog uroliths removed?
What is the surgical treatment option if stones cannot be removed?
Ureterotomy - lineal incision in ureter
or retroreage urethral flushing and then cystotomy
Urethrostomy - Scrotal, prescrotal (or perineal)
in cats the ureter is too small for ureterotomy what is done instead if there is uroliths in the ureter?
Place a stent from the kideny through the ureter into the bladder
or
Submucosal ureteral bypass system (SUBS) - from kidney to the bladder not via the ureter - issues with blocking and infection
Perineal Urethrostomy - bring the wide part of the urethra to the perineum, remove the penis
