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CVNT2 > Surgical Diseases of the Urinary Tract > Flashcards

Surgical Diseases of the Urinary Tract Flashcards

1
Q

What should initial investigation of a suspected urinary tract disease involve?

A

Bloods
Urinalysis
Radiography/IV urography
Ultrasonography

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2
Q

What can be seen via ultrasonography?

A

Structure and definition of kidneys/ureters/bladder/urethra

Uroliths, masses, lesions, inflammatory disorders, prostatic diseases

Ectopic diseases

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3
Q

How can you lessen the potential for wound contamination/infection during urinary surgery?

A

Use antibiotic cover (especially in presence of known UTI)

Minimise spillage of urine with laparotomy swabs packed around bladder

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4
Q

What surgical equipment is useful in urinary surgery?

A 
Fine instruments and suture material 
Abdominal retractors 
Tubes for cystotomy 
Urethral catheters 
Suction 
Spoons for bladder stones 
Magnification
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5
Q

What are some common surgical diseases of the kidneys?

A

Neoplasia
Trauma
Renoliths (renal stones)
Diseases secondary to ureteric disease

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6
Q

What type of tumour is the most common in dogs?

A

Carcinoma

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7
Q

What are the clinical signs of renal neoplasia?

A

Haematuria

Palpable abdominal mass

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8
Q

What is the most common renal tumour in cats?

A

Lymphoma

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9
Q

Why is surgery not often recommended for renal stones?

A

They are often seen in animals with concurrent chronic renal failure

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10
Q

What is the common treatment for renal stones?

A

Many can be dissolved with diet and antibiotic therapy

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11
Q

What is a nephrotomy?

A

Incision through the body of the kidney

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12
Q

When might a subcutaneous ureteral bypass be required?

A

In patients with a blocked ureter (calcium oxalate stones) which cannot be medically dissolved

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13
Q

What are some causes of kidney disease secondary to ureteric disease?

A

Ureters undergo trauma during spay surgery

Ureteral obstruction can be managed by nephrectomy

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14
Q

What is a nephrectomy?

A

Surgical removal of a kidney

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15
Q

Why might a nephrectomy be required?

A

Renal neoplasia or trauma
Chronic pyelonephritis
Idiopathic haematuria

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16
Q

Why is it important to blood type a patient prior to nephrectomy?

A

Potential for severe haemorrhage

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17
Q

What is ureteral ectopia?

A

Congenital anomaly in dogs resulting in ureters opening into urethra instead of bladder

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18
Q

What is the surgical treatment for ureteral ectopia?

A

Neo-ureterostomy

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19
Q

How successful is neo-ureterostomy surgery?

A

50% of affected remain incontinent due to congenital urethral sphincter incontinence

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20
Q

What are the common surgical diseases of the bladder?

A

Uroliths
Neoplasia
Trauma

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21
Q

What is the most common type of urolith in UK?

A

Struvite

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22
Q

Which types of uroliths are amenable to medical dissolution?

A

Struvite and urate uroliths

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23
Q

How are uroliths causing obstruction/severe clinical signs removed?

A

Via surgery - cystotomy

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24
Q

What signs do bladder stone patients present with?

A

Haematuria
Frequency/urgency to urinate
Complete obstruction (severe - emergency)

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25
Q

What signs do bladder neoplasia patients present with?

A

Haematuria
Frequency/urgency to urinate
Complete obstruction (severe - emergency)

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26
Q

In what location can bladder neoplasia not be excised?

A

If affecting the trigone/bladder neck

27
Q

What is the consequence of bladder trauma/rupture?

A

Uroabdomen

Post-renal failure

28
Q

What is the treatment for bladder trauma/rupture?

A

IVFT to stabilise patient

Surgical repair or indwelling catheter may allow healing

29
Q

When might a cystotomy be performed?

A

For visualisation and removal of bladder stones

30
Q

What should happen to stones removed during cystotomy?

A

Submit for lab analysis for composition and culture and sensitivity

31
Q

What observations should be done post-op for cystotomy?

A

Observe for absence of urination or abdominal distension

Ensure plenty of opportunities for urination

32
Q

What are the most common urethral stones in UK?

A

Struvite (mostly males due to anatomy)

33
Q

What should be involved in management of urethral stones?

A

Restore circulating volume, reduce hyperkalaemia and relieve obstruction

34
Q

How should urethral obstructions be relieved?

A

Empty bladder by cystocentesis
Careful urethral catheterisation

If unsuccessful, attempt retrograde flushing with sterile saline and then remove via cystotomy

35
Q

What is a USMI?

A

Urethral sphincter mechanism incontinence

36
Q

How can USMI be medically managed?

A

Oestrogen or phenylopropanolamine

37
Q

How else can USMI be treated if it does not respond to medication?

A

Surgically -
Colposuspension
Urethropexy
Hydraulic artificial urethral sphincters

38
Q

What is colposuspension?

A

Treatment of USMI - moving bladder neck and proximal urethra to an intra-abdominal position to lengthen urethra

39
Q

What is urethropexy?

A

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

40
Q

What is FLUTD?

A

Feline lower urinary tract disease

41
Q

When is FLUTD considered a surgical disease?

A

When males suffer repeated episodes of urethral obstruction

42
Q

Which cats are most prone to FLUTD?

A

Overweight, neutered, middle age, indoor cats, with dry diet

43
Q

What are some of the causes of FLUTD?

A

Bacterial infection

Urethral spasming

FIC

Neoplasia

Blockages by stones/plug

44
Q

What is the most common form of urethral neoplasia?

A

Transitional cell carcinoma

45
Q

What is the most common form of urethral neoplasia?

A

Transitional cell carcinoma

46
Q

What is the treatment for urethral neoplasia?

A

Too advanced for surgical excision

By-passing the urethra may provide palliation (urethral stents, tube cystotomy)

47
Q

What is a urethrotomy?

A

Incision into the urethra

48
Q

What is a urethrostomy?

A

Creation of a permanent new opening

49
Q

What types of urethrostomy are commonly performed in the dog and cat?

A

Scrotal urethrostomy in dog

Perineal urethrostomy in cat

50
Q

Why might a tube cystotomy be performed?

A

Used as a urinary diversion technique

Diverting urine away from urethral surgical sites/neoplasia/detrusor atony

51
Q

What considerations should be taken after urethral surgery?

A

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)

52
Q

What are the possible causes of prostatic disease in dogs?

A 
Benign hyperplasia 
Protastitis 
Abscessation 
Cysts 
Neoplasia
53
Q

What is benign prostatic hyperplasia?

A

Non-cancerous increase in prostate size

54
Q

How is benign prostatic hyperplasia managed?

A

Castration if entire

Anti-androgens

55
Q

What is prostatitis?

A

Inflammation of the prostatic gland (bacterial infection?)

56
Q

What are the symptoms of prostatitis?

A

Dysuria, pyrexia,

purulent penile discharge

57
Q

How is prostatitis managed?

A

Antibiotics and Tardak (anti-androgens)

Castration if entire

58
Q

What are the symptoms of a prostatic abscess?

A

Usually with prostatitis (entire males)

dysuria/dyschezia

59
Q

How can prostatic abscesses be treated?

A

Castration

Omentalisation following re-roofing and flushing of the abscess

60
Q

What can result if a prostatic abscess bursts?

A

Septic peritonitis (emergency)

61
Q

What causes a prostatic cyst?

A

Prostatic ducts get blocked leading to a buildup of fluid, leading to cysts
(entire males)

62
Q

How are prostatic cysts treated?

A

Castration

De-roof and omentalisation

63
Q

What is the prognosis for prostatic neoplasia? How can animals be palliated?

A

Poor

Can be palliated with urethral stents (if unable to urinate)

64
Q

How should urethral obstructions be relieved?

A

Empty bladder by cystocentesis
Careful urethral catheterisation

If unsuccessful, attempt retrograde flushing with sterile saline and then remove via cystotomy

CVNT2 (47 decks)

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