Surgery of urinary tract - Kidneys & Bladder Flashcards
What suture material should be used for urogenital surgery?
absorbable monofilament
Which kidney is more cranial?
Right
Which kidney is more mobile?
Left
What are the developmental anomalies of the kidneys?
How common are they?
- Renal agenesis (kidney and ureter not present)
- Renal dysplasia (disorganised parenchyma)
- Renal ectopia
- Polycystic kidney disease (Persians, Bull terriers)
UNCOMMON
What can a renal biopsy indicate?
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
When would you perform a renal biopsy?
- Perform after thorough evaluation of the patient
What does a thorough evaluation of the patient consist of?
Haematology
Serum biochemistry
Urinalysis/urine bacteriology
Diagnostic Imaging
Coagulation profile
What are the 3 renal biopsy methods?
- Fine Needle Aspirate (FNA)
- Tru-cut or Spring-loaded Biopsy instrument - 14-18G
- Surgical
What are the approaches to taking a renal biopsy?
- Percutaneous (blind) biopsy – not recommended
- Ultrasound-guided biopsy
- Keyhole biopsy – flank approach
- Laparoscopic biopsy
- Ventral midline coeliotomy
What is nephrotomy?
Incision into the kidney
When would you perform nephrotomy?
*wedge biopsy
*nephrolith removal
What are the clinical signs of nephroliths?
*Lumbar/abdominal pain
*haematuria
*recurrent UTI
*azotaemia
What is the treatment of nephroliths?
Medical management
Calcium oxalate do not respond to medical management
Surgical management – consider referral!
What is URETERONEPHRECTOMY?
Removal of Kidney and ureter
When would you partake in URETERONEPHRECTOMY?
Trauma
Hydronephrosis (ligated ureter?!)
Renomegaly/renal masses – neoplasia
Management of single ureteral ectopia ?
Harvest kidney for transplantation
Must have working other kidney
When would you perform partial nephrectomy?
- 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
What renal neoplasia is most common in cats + dogs?
- Cats: lymphoma (usually bilateral)
- Dogs: renal cell carcinoma (90% of all renal
malignancies)
How would you investigate renal neoplasia?
- 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
How would you treat neoplasia?
- 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
What are the congenital abnormalities of the bladder?
Patent urachus: fetal communication between bladder and alantoic sac persists
Vesicourachal diverticulum: external opening of urachus closes but blind-ending diverticulum remains open
What is cystotomy?
Incision of the bladder
When would you perform cystotomy?
Removal of calculi
Repair of bladder trauma
Biopsy or resection of bladder masses
Biopsy of bladder wall
Repair of ectopic ureters
How would you approach a cystotomy?
- 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
How long does it take bladder incisions to heal?
2/3 weeks
What are the post op complications of cystotomy?
- Haematuria
- Dysuria
- Uroabdomen – not common
What are the causes of bladder rupture?
Trauma
Bladder neoplasia
Urethral obstruction by calculi or neoplasia
Iatrogenic: cystocentesis, catheterisation, manual expression
How would you diagnose bladder rupture?
- History
- Clinical examination
- Absence of urine/haematuria on catheterization
- Urethral obstruction at attempted cathererisation
- Azotaemia, dehydration, metabolic acidosis,
hyperkalaemia - Abdominocentesis
- Abdominal ultrasonography
How would you treat/manage bladder rupture?
- 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
What is the most common bladder neoplasia?
Transitional cell carcinoma
What is the treatment for bladder neoplasia?
- 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
