Surgical Management of Urinary Tract Disease Flashcards
otomy means…
to open (and then close)
ostomy means…
to open and create new stoma
tectomy means…
to remove
What surgeries are recommended for the removal of lower urinary tract Uroliths?
Cystotomy- open bladder (following retrograde hydropropulsion)
Urethrotomy- open up narrow areas of the urethra
What are some complications associated with Cystotomy?
Urolith recurrence
Cystotomy breakdown leading to uroabdomen
Haematuria/ blood clot leading to obstructions
When is a Cystectomy indicated? (4)
[removal of all or some of urinary bladder]
neoplasia, polyps, necrosis, patent urachus
How much of the bladder can be removed in a Cystectomy for it to still be functional?
40-70%
When is a Urethrotomy indicated?
when obstruction cannot be returned to the bladder e.g. if urolith is in the glans penis or perineal tissue
What suture type and pattern do we use for Urethrotomy?
Monofilament absorbable
Simple continuous or simple interrupted
In what ways can we create urinary diversions surgically?
Permanent Urethrostomy (new opening into the urethra)
OR with a Cystotomy tube
Where do we perform Permanent Urethrostomy in cats/ dogs?
via the scrotum for male dogs
perineal (male cat)
or pre pubic (both)
When is a Urethrostomy indicated?
if there is a permanent obstruction, in recurrent cases or in cases of irreparable injury/ disease
Why is urethrostomy in the scrotum the preferred site? (3)
Urethra is wider
Urethra is more superficial here
Less cavernous tissue so less risk of haemorrhage
What suture type and pattern do we use for Urethrostomy?
Monofilament absorbable
Simple continuous or simple interrupted
What is necessary for the patient before a scrotal urethrostomy?
Castration
What is involved in a perineal urethrostomy?
Penile amputation and surgical connection of the pelvic urethra to the skin
When would we perform a pre-pubic urethrostomy in first opinion practice?
We wouldn’t- we would consider referral for this as it is a complex procedure
What is a Cystotomy?
cutaneous urinary diversion from the bladder
When would a Cystotomy be indicated?
In cases of bladder decompression if catheter cannot be placed via the urethra
To protect the urethra following injury/ surgery
What suture patterns are used in a Cystotomy tube placement?
Purse string suture
Box suture
Roman-sandal suture
How long do we keep a temporary cystotomy tube in?
at least one week to allow adhesion between bladder and abdominal wall
In cases of Ureteral obstruction, what are the preferred surgical methods of treating it?
Ureterotomy (incision into the ureter)
Subcutaneous ureteral bypass system (bypasses the ureter and diverts urine from the kidney to the bladder)
When would we perform surgery to treat Urinary Incontinence?
Only if medical interventions have failed and a specific diagnosis has been reached
What procedures can be performed to treat USMI?
Bladder neck relocation/ urethral neck lengthening
Increasing urethral resistance
How successful are surgical procedures aimed at fixing USMI?
Not very- 33-56% success
What two ways can we increase urethral resistance to treat USMI and when are these indicated?
Injecting bulking agent into the urethra- indicated as palliative for older patients as it reabsorbed after 6 months
Synthetic sphincter- indicated for young patients who need long term prevention
