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MOD > Surgery of urinary tract - Kidneys & Bladder > Flashcards

Surgery of urinary tract - Kidneys & Bladder Flashcards

1
Q

What suture material should be used for urogenital surgery?

A

absorbable monofilament

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2
Q

Which kidney is more cranial?

A

Right

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3
Q

Which kidney is more mobile?

A

Left

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4
Q

What are the developmental anomalies of the kidneys?
How common are they?

A
  • Renal agenesis (kidney and ureter not present)
  • Renal dysplasia (disorganised parenchyma)
  • Renal ectopia
  • Polycystic kidney disease (Persians, Bull terriers)
    UNCOMMON
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5
Q

What can a renal biopsy indicate?

A

 Renal mass (commonest indication)
 Haematuria of upper urinary tract origin
 Renal cortical disease / Protein-losing glomerulopathy
 Renal failure where underlying cause cannot be determined
 Evaluation of severity, reversibility or progression of renal disease

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6
Q

When would you perform a renal biopsy?

A
  • Perform after thorough evaluation of the patient
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7
Q

What does a thorough evaluation of the patient consist of?

A

 Haematology
 Serum biochemistry
 Urinalysis/urine bacteriology
 Diagnostic Imaging
 Coagulation profile

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8
Q

What are the 3 renal biopsy methods?

A
  • Fine Needle Aspirate (FNA)
  • Tru-cut or Spring-loaded Biopsy instrument - 14-18G
  • Surgical
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9
Q

What are the approaches to taking a renal biopsy?

A
  • Percutaneous (blind) biopsy – not recommended
  • Ultrasound-guided biopsy
  • Keyhole biopsy – flank approach
  • Laparoscopic biopsy
  • Ventral midline coeliotomy
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10
Q

What is nephrotomy?

A

Incision into the kidney

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11
Q

When would you perform nephrotomy?

A

*wedge biopsy
*nephrolith removal

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12
Q

What are the clinical signs of nephroliths?

A

*Lumbar/abdominal pain
*haematuria
*recurrent UTI
*azotaemia

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13
Q

What is the treatment of nephroliths?

A

 Medical management
 Calcium oxalate do not respond to medical management
 Surgical management – consider referral!

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14
Q

What is URETERONEPHRECTOMY?

A

Removal of Kidney and ureter

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15
Q

When would you partake in URETERONEPHRECTOMY?

A

 Trauma
 Hydronephrosis (ligated ureter?!)
 Renomegaly/renal masses – neoplasia
 Management of single ureteral ectopia ?
 Harvest kidney for transplantation

Must have working other kidney

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16
Q

When would you perform partial nephrectomy?

A
  • Suitable if benign, small localised disease at the pole of kidney
  • Unilateral nephrectomy previously performed
  • Salvages some renal function
  • Technically more difficult, risk of postoperative
    haemorrhage, urine leakage, urine fistula
17
Q

What renal neoplasia is most common in cats + dogs?

A
  • Cats: lymphoma (usually bilateral)
  • Dogs: renal cell carcinoma (90% of all renal
    malignancies)
18
Q

How would you investigate renal neoplasia?

A
  • Abdominal palpation
  • Haematology and serum biochemistry
  • Radiography
  • Computed tomography
  • Abdominal ultrasound
  • Biopsy (FNA, Tru-cut, excisional)
  • CHECK FOR METASTASIS!
    Lymph nodes, lung, liver, bone in >50% of carcinomas
    Include thoracic imaging as part of investigations
19
Q

How would you treat neoplasia?

A
  • Lymphoma: chemotherapy, not surgical disease
  • Unilateral renal neoplasia with no gross metastasis
     Ureteronephrectomy
     Surgery can be challenging due to neovascularization
     Surgery is palliative until metastases become apparent
20
Q

What are the congenital abnormalities of the bladder?

A

 Patent urachus: fetal communication between bladder and alantoic sac persists
 Vesicourachal diverticulum: external opening of urachus closes but blind-ending diverticulum remains open

21
Q

What is cystotomy?

A

Incision of the bladder

22
Q

When would you perform cystotomy?

A

 Removal of calculi
 Repair of bladder trauma
 Biopsy or resection of bladder masses
 Biopsy of bladder wall
 Repair of ectopic ureters

23
Q

How would you approach a cystotomy?

A
  • Ventral midline coeliotomy umbilicus to pubis
  • Isolate bladder from rest abdomen with moistened lap swabs
  • Place stay sutures
  • Ventral cystotomy with blade
  • Suction urine
  • Extend incision with Metzenbaum scissors
24
Q

How long does it take bladder incisions to heal?

A

2/3 weeks

25
Q

What are the post op complications of cystotomy?

A
  • Haematuria
  • Dysuria
  • Uroabdomen – not common
26
Q

What are the causes of bladder rupture?

A

 Trauma
 Bladder neoplasia
 Urethral obstruction by calculi or neoplasia
 Iatrogenic: cystocentesis, catheterisation, manual expression

27
Q

How would you diagnose bladder rupture?

A
  • History
  • Clinical examination
  • Absence of urine/haematuria on catheterization
  • Urethral obstruction at attempted cathererisation
  • Azotaemia, dehydration, metabolic acidosis,
    hyperkalaemia
  • Abdominocentesis
  • Abdominal ultrasonography
28
Q

How would you treat/manage bladder rupture?

A
  • Small tears will heal spontaneously, place indwelling catheter for 1-3 days
  • Fluid therapy + urine drainage
  • To normalise electrolyte levels, improve hydration + decrease azotaemia
  • Indwelling catheter
  • Exploratory laparotomy
  • Identify and repair defect
  • Closure as for cystotomy or over a Foley catheter
  • Lavage abdomen and suction fluid
  • Omentalisation
29
Q

What is the most common bladder neoplasia?

A

Transitional cell carcinoma

30
Q

What is the treatment for bladder neoplasia?

A
  • Chemotherapy
  • Non-steroidal anti-inflammatory drugs (NSAIDS)
  • Cystostomy tube
  • Urethral stenting: urinary incontinence 25-40%, migration, reobstruction
  • Partial cystectomy: up to 75%, not if trigone affected

MOD (103 decks)

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