surgical diseases of urinary tract 1+2 Flashcards
upper urinary tract
kidneys and ureters
lower urinary tract
bladder and urethra
history questions
- neuter status
- continence? (control of bladder)
- can patient void bladder normally?
- unproductive urination?
- vocalisation whilst urinating?
- house soiling?
- smell of urine?
- blood in urine?
- frequency of urination
- drinking more than usual?
initial investigations
- bloods (haem)
- urinalysis (USG, dipstick, sediment, culture)
- radiography
- ultrasonography
instruments and equipment for urinary surgery
- abdominal retractors
- stay sutures/small retractors
- tubes for cystotomy
- urethral catheters
- suction
- magnification
- sterile cotton buds
surgical diseases of the kidney
- neoplasia
- trauma
- renoliths (renal stones)
- kidney disease secondary to uretic disease
renal neoplasia clinical signs, contraindications
carcinoma- most common in dogs
lymphoma- most common in cats
clinical signs- palpable mass, haematuria
contraindications for surgical intervention:
- pulmonary metastases
- bilateral neoplasia
causes of renal trauma
- RTA
- dog bite
renal stones
- similar to uroliths
- seen in concurrent cronic renal failure
- can be dissolved through renal diet and antibiotics
- surgery not recommended
subcutaneous ureteral bypass (SUB)
- indicated in patients with uni/bilateral blocked ureters
- can be causes by calcium oxalate stones (can’t be medically dissolved)
- tubing placed within kidney and connected to bladder
kidney disease secondary to ureteric disease
can be caused by trauma to ureters, ureteroliths (obstruction)
- managed by ureterotomy or intra-ureteral stent
nephrectomy indications
- neoplasia
- trauma
- chronic pyelonephritis
- idiopathic haematuria
- ureteral abnormalaties
surgical diseases of the ureters
- trauma during another surgery
- ureteroliths
- ureteral ectopia
ureteral ectopia definition
- congenital abnormality (dogs)
- ureters open into the urethra, bypassing the bladder
- can happen in the bladder (intramural)
treatment= neoureterostomy - monitor for stranguria post op
- common for incontinence post op
surgical diseases of the bladder
- uroliths (bladder stones)
- neoplasia
- trauma
uroliths clinical signs
- haematuria
- polyuria, urgency of urination
- obstruction
urolith treatment
- struvite an urate uroliths can be medically dissolved
- other uroliths and those causing obstruction are removed by cystotomy
- urinary diet for prevention
bladder neoplasia
clinical signs:
- haematuria, polyuria, obstruction
most are malignant
- partial cystectomy may be useful for palliation
- unless it affects bladder neck/trigone
bladder trauma/rupture
- leads to uroabdomen and post-renal failure
- IVFT to stabilise patient
- surgical repair of bladder and indwelling urinary catheter
cystotomy
- for removal of bladder stones
- submit stones for analysis
- monitor post-op for anuria, abdominal distension
urethral diseases
- urolithiasis
- incontinence
- feline lower urinary tract disease
- trauma
- neoplasia
urinary incontinence
- congenital or acquired
- most common in females
- rare in cats
USMI= urethral sphincter mechanism incontinence risk factors
- breed disposition (sheep dogs)
- neutering, obesity, congenital, intrapelvic bladder
USMI treatment
- medically= oestrogen, phenylpropanolamine
- surgical= colposuspension, urethropexy, hydraulic artificial urethral sphincters
-pexy
- sutured to body wall
FLUTD
causes: urethral spasms, bacterial infections, neoplasia
- secondary to bladder disease
- can lead to urethral obstruction in some male cats
- some can be managed medically
urethral neoplasia
- rare cause of obstruction usually in old female cats
- usually too advanced for surgical excision
- by-passing the urethra may provide palliation
2 routes into urethral surgery
- urethrotomy (incision into urethra)
- last resort for stones that can’t be flushed back into bladder
- urethrostomy (new opening)
- last resort for recurrent obstruction or severe trauma of urethra
tube cystotomy
- urinary diversion away from urethral surgical sites
- catheter is passed through body wall and cystopexy is performed
- tube must be in place for 7 days before removal
- risk of UTI
urethrostomy
- usually males
cats= in perineum/prepubic
dogs= scrotal/perineal
post op care in urinary surgery patients
- indwelling urinary catheter care
- BP monitoring to maintain renal perfusion (IVFT)
- restriction of patient interference
- haematuria common for 7ish days
- monitor for dysuria, haemorrhage, analgesia
- dressing care
prostatic disease causes
- prostate surrounds urethra in males
- disease rare in cats
causes in dogs: - benign hyperplasia (enlargement)
- prostatitis (inflammation)
- abscessation/cysts
- neoplasia
benign prostatic hyperplasia
- enlargement of prostate
- seen in older entire males
- can cause dysuria or ischaemia
- managed medically with anti-androgens or castration
prostatitis
- bacterial infection can occur with BPH
- entire males
clinical signs: dysuria, pyrexia, purulent penile discharge - managed medically with antibiotics/anti-androgens or castration
prostatic abscesses
- alongside prostatitis in entire males
clinical signs: dysuria, dyschezia and systemic signs - managed through omentalisation following flushing of abscess, then castration
prostatic cysts
- entire males associated with BPH
- less common are paraprostatic cysts
- treat with flushing, omentalisation, and castration
- occasionally due to underlying neoplasia
prostatic neoplasia
- elderly dogs
- more common in castrated unlike other prostatic disease
- palliation :(
