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SA surgical diseases > Surgical diseases of urinary tract > Flashcards

Surgical diseases of urinary tract Flashcards

1
Q

What are some signs of urinary tract disease?

A

Stranguria, polyuria, anuria, dysuria
-vomiting

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2
Q

When is nuclear scintigraphy helpful in urinary cases?

A

If worried about GFR and kidney function

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3
Q

Where are the kidneys located?

A

In the retroperitoneal space

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4
Q

Which kidney is more mobile?

A

The left

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5
Q

What are the natural retractors for the kidney?

A

Mesocolon for left side

Mesoduodenum on right

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6
Q

Which renal artery is often paired?

A

The left

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7
Q

What size should you expect a kidney to be on radiographs?

A

2-2.5 times the length of adjacent vertebrae

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8
Q

What are some techniques for renal biopsy? why are these techniques being replaced by less invasive procedures?

A

Percutaneous, keyhole celiotomy, laparoscopic

  • to preserve kidney function-often can damage kidney with these procedures
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9
Q

What are the indications for nephrotomy?

A

Wedge biopsy, chronic infections or hematuria, renal calculi, persistent hydronephrosis

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10
Q

Why is a pyelolithotomy preferred over a nephrotomy?

A

It causes no occlusion of the renal blood flow or damage to the renal parenchyma

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11
Q

What are some indications for nephrectomy?

A

Hydronephrosis (urolithiasis, stricture, mass, iatrogenic), renal neoplasia, renal cysts/abscesses, trauma (ruptured kidney, avulsion of renal artery), infection (dioctophyma renale aka kidney worm)

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12
Q

Describe the basic steps of a nephrectomy.

A
  1. Midline celiotomy
  2. retraction and visualization
  3. incise peritoneum and free kidney from sublumbar attachments, reflect medially to expose vessels (then isolate, triple ligate and divide)
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13
Q

Where should the ureters be cut during a nephrectomy?

A

Right at the bladder to prevent additional areas for UTIs

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14
Q

What type of suture should you use when placing encircling ligatures on renal vasculature?

A

Vicryl, silk, PDS
-can also use Thoracoabdominal stapling device

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15
Q

Which vessel should be ligated first- the artery or vein?

A

Whatever is easier- goal is to get out as soon as possible

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16
Q

What post op care and potential complications is important in nephrectomy cases?

A

Fluid therapy, analgesics

-hemorrhage and renal dysfunction of remaining kidney

17
Q

If there is ureteral changes seen on a radiograph after contrast, what should you do?

A

REFER
- ureters are prone to leakage and stricture
-most common procedures done are neoureterocystotomy (for ectopic ureters), and ureterotomy (to remove calculi)

18
Q

What are stents used for with urethral blockages?

A

Essentially bypasses the stricture- creates a new path

19
Q

What is the subcutaneous renal bypass system?

A

Creating a new path for the urine to flow from kidney to bladder- creating “false” ureter

20
Q

What is so special about the trigone region?

A

Needs to be preserved in surgery due to entrance of ureters, and is the area that initiates healing

21
Q

What are the sources of blood supply for the bladder?

A

Cranial vesicular artery (branch of umbilical) and caudal vesicular artery (main one- branch of urogenital), internal pudendal veins

22
Q

What nerves are the bladder innervated by?

A

Hypogastric provides sympathetic innervation, pelvic provides parasympathetic and pudendal exerts a somatic role (innervates external urethral sphincter)

23
Q

What is the difference in appearance of stones and masses on ultrasound of the bladder?

A

Stones will be very hyperechoic and cast shadows, masses will have same opacity as the wall

24
Q

What else can show up in the lumen of the bladder besides stones and masses?

A

Blood clots

25
Q

What are the indications for cystotomy?

A

Removal of calculi, exploration of urinary bladder (biopsy and culture), neoplasia removal, repair of ectopic ureters, trauma

26
Q

What are the steps to a cystotomy?

A
  1. Cut
  2. Explore completely (evert bladder, inspect mucosa)
  3. Biopsy/culture wall or stones
  4. Catheterize from both directions to be sure you can flush in both directions to be sure everything gets out
27
Q

What is the holding layer of the bladder?

A

The submucosa
- be sure to avoid penetrating mucosa

28
Q

How long does the bladder take to heal?

A

14-21 days
- mucosa re-epithelializes in 30 days

29
Q

What should you always do after closure in cystotomy cases?

A

Post op radiographs

30
Q

What should you do with stones removed?

A

Send out for culture
- important for post op antibiotic use and recommended diet

31
Q

What are the indications for partial cystectomy?

A

Trauma, neoplasia

32
Q

What is a perineal urethrostomy best for?

A

Repeat offenders
-failed medical management

SA surgical diseases (11 decks)

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