Surgical Diseases of the Urinary Tract Flashcards
What should initial investigation of a suspected urinary tract disease involve?
Bloods
Urinalysis
Radiography/IV urography
Ultrasonography
What can be seen via ultrasonography?
Structure and definition of kidneys/ureters/bladder/urethra
Uroliths, masses, lesions, inflammatory disorders, prostatic diseases
Ectopic diseases
How can you lessen the potential for wound contamination/infection during urinary surgery?
Use antibiotic cover (especially in presence of known UTI)
Minimise spillage of urine with laparotomy swabs packed around bladder
What surgical equipment is useful in urinary surgery?
Fine instruments and suture material Abdominal retractors Tubes for cystotomy Urethral catheters Suction Spoons for bladder stones Magnification
What are some common surgical diseases of the kidneys?
Neoplasia
Trauma
Renoliths (renal stones)
Diseases secondary to ureteric disease
What type of tumour is the most common in dogs?
Carcinoma
What are the clinical signs of renal neoplasia?
Haematuria
Palpable abdominal mass
What is the most common renal tumour in cats?
Lymphoma
Why is surgery not often recommended for renal stones?
They are often seen in animals with concurrent chronic renal failure
What is the common treatment for renal stones?
Many can be dissolved with diet and antibiotic therapy
What is a nephrotomy?
Incision through the body of the kidney
When might a subcutaneous ureteral bypass be required?
In patients with a blocked ureter (calcium oxalate stones) which cannot be medically dissolved
What are some causes of kidney disease secondary to ureteric disease?
Ureters undergo trauma during spay surgery
Ureteral obstruction can be managed by nephrectomy
What is a nephrectomy?
Surgical removal of a kidney
Why might a nephrectomy be required?
Renal neoplasia or trauma
Chronic pyelonephritis
Idiopathic haematuria
Why is it important to blood type a patient prior to nephrectomy?
Potential for severe haemorrhage
What is ureteral ectopia?
Congenital anomaly in dogs resulting in ureters opening into urethra instead of bladder
What is the surgical treatment for ureteral ectopia?
Neo-ureterostomy
How successful is neo-ureterostomy surgery?
50% of affected remain incontinent due to congenital urethral sphincter incontinence
What are the common surgical diseases of the bladder?
Uroliths
Neoplasia
Trauma
What is the most common type of urolith in UK?
Struvite
Which types of uroliths are amenable to medical dissolution?
Struvite and urate uroliths
How are uroliths causing obstruction/severe clinical signs removed?
Via surgery - cystotomy
What signs do bladder stone patients present with?
Haematuria
Frequency/urgency to urinate
Complete obstruction (severe - emergency)
What signs do bladder neoplasia patients present with?
Haematuria
Frequency/urgency to urinate
Complete obstruction (severe - emergency)
In what location can bladder neoplasia not be excised?
If affecting the trigone/bladder neck
What is the consequence of bladder trauma/rupture?
Uroabdomen
Post-renal failure
What is the treatment for bladder trauma/rupture?
IVFT to stabilise patient
Surgical repair or indwelling catheter may allow healing
When might a cystotomy be performed?
For visualisation and removal of bladder stones
What should happen to stones removed during cystotomy?
Submit for lab analysis for composition and culture and sensitivity
What observations should be done post-op for cystotomy?
Observe for absence of urination or abdominal distension
Ensure plenty of opportunities for urination
What are the most common urethral stones in UK?
Struvite (mostly males due to anatomy)
What should be involved in management of urethral stones?
Restore circulating volume, reduce hyperkalaemia and relieve obstruction
How should urethral obstructions be relieved?
Empty bladder by cystocentesis
Careful urethral catheterisation
If unsuccessful, attempt retrograde flushing with sterile saline and then remove via cystotomy
What is a USMI?
Urethral sphincter mechanism incontinence
How can USMI be medically managed?
Oestrogen or phenylopropanolamine
How else can USMI be treated if it does not respond to medication?
Surgically -
Colposuspension
Urethropexy
Hydraulic artificial urethral sphincters
What is colposuspension?
Treatment of USMI - moving bladder neck and proximal urethra to an intra-abdominal position to lengthen urethra
What is urethropexy?
Treatment of USMI - increases pull and tone of urethral muscles, by using sutures to stretch out the urinary tract and increase the force required to urinate
What is FLUTD?
Feline lower urinary tract disease
When is FLUTD considered a surgical disease?
When males suffer repeated episodes of urethral obstruction
Which cats are most prone to FLUTD?
Overweight, neutered, middle age, indoor cats, with dry diet
What are some of the causes of FLUTD?
Bacterial infection
Urethral spasming
FIC
Neoplasia
Blockages by stones/plug
What is the most common form of urethral neoplasia?
Transitional cell carcinoma
What is the most common form of urethral neoplasia?
Transitional cell carcinoma
What is the treatment for urethral neoplasia?
Too advanced for surgical excision
By-passing the urethra may provide palliation (urethral stents, tube cystotomy)
What is a urethrotomy?
Incision into the urethra
What is a urethrostomy?
Creation of a permanent new opening
What types of urethrostomy are commonly performed in the dog and cat?
Scrotal urethrostomy in dog
Perineal urethrostomy in cat
Why might a tube cystotomy be performed?
Used as a urinary diversion technique
Diverting urine away from urethral surgical sites/neoplasia/detrusor atony
What considerations should be taken after urethral surgery?
Absolute prevention of patient interference
Haematuria, but should resolve within a few days
Care with litter (shredded newspaper)
Observe for dysuria
Keep an eye on post-op BP
Pain relief (opioids)
What are the possible causes of prostatic disease in dogs?
Benign hyperplasia Protastitis Abscessation Cysts Neoplasia
What is benign prostatic hyperplasia?
Non-cancerous increase in prostate size
How is benign prostatic hyperplasia managed?
Castration if entire
Anti-androgens
What is prostatitis?
Inflammation of the prostatic gland (bacterial infection?)
What are the symptoms of prostatitis?
Dysuria, pyrexia,
purulent penile discharge
How is prostatitis managed?
Antibiotics and Tardak (anti-androgens)
Castration if entire
What are the symptoms of a prostatic abscess?
Usually with prostatitis (entire males)
dysuria/dyschezia
How can prostatic abscesses be treated?
Castration
Omentalisation following re-roofing and flushing of the abscess
What can result if a prostatic abscess bursts?
Septic peritonitis (emergency)
What causes a prostatic cyst?
Prostatic ducts get blocked leading to a buildup of fluid, leading to cysts
(entire males)
How are prostatic cysts treated?
Castration
De-roof and omentalisation
What is the prognosis for prostatic neoplasia? How can animals be palliated?
Poor
Can be palliated with urethral stents (if unable to urinate)
How should urethral obstructions be relieved?
Empty bladder by cystocentesis
Careful urethral catheterisation
If unsuccessful, attempt retrograde flushing with sterile saline and then remove via cystotomy
