Surgical Management of Urinary Tract Disease

Question 1

otomy means…

Answer 1

to open (and then close)

Question 2

ostomy means…

Answer 2

to open and create new stoma

Question 3

tectomy means…

Answer 3

to remove

Question 4

What surgeries are recommended for the removal of lower urinary tract Uroliths?

Answer 4

Cystotomy- open bladder (following retrograde hydropropulsion)
Urethrotomy- open up narrow areas of the urethra

Question 5

What are some complications associated with Cystotomy?

Answer 5

Urolith recurrence
Cystotomy breakdown leading to uroabdomen
Haematuria/ blood clot leading to obstructions

Question 6

When is a Cystectomy indicated? (4)

[removal of all or some of urinary bladder]

Answer 6

neoplasia, polyps, necrosis, patent urachus

Question 7

How much of the bladder can be removed in a Cystectomy for it to still be functional?

Answer 7

40-70%

Question 8

When is a Urethrotomy indicated?

Answer 8

when obstruction cannot be returned to the bladder e.g. if urolith is in the glans penis or perineal tissue

Question 9

What suture type and pattern do we use for Urethrotomy?

Answer 9

Monofilament absorbable
Simple continuous or simple interrupted

Question 10

In what ways can we create urinary diversions surgically?

Answer 10

Permanent Urethrostomy (new opening into the urethra)
OR with a Cystotomy tube

Question 11

Where do we perform Permanent Urethrostomy in cats/ dogs?

Answer 11

via the scrotum for male dogs
perineal (male cat)
or pre pubic (both)

Question 12

When is a Urethrostomy indicated?

Answer 12

if there is a permanent obstruction, in recurrent cases or in cases of irreparable injury/ disease

Question 13

Why is urethrostomy in the scrotum the preferred site? (3)

Answer 13

Urethra is wider
Urethra is more superficial here
Less cavernous tissue so less risk of haemorrhage

Question 14

What suture type and pattern do we use for Urethrostomy?

Answer 14

Monofilament absorbable
Simple continuous or simple interrupted

Question 15

What is necessary for the patient before a scrotal urethrostomy?

Answer 15

Castration

Question 16

What is involved in a perineal urethrostomy?

Answer 16

Penile amputation and surgical connection of the pelvic urethra to the skin

Question 17

When would we perform a pre-pubic urethrostomy in first opinion practice?

Answer 17

We wouldn’t- we would consider referral for this as it is a complex procedure

Question 18

What is a Cystotomy?

Answer 18

cutaneous urinary diversion from the bladder

Question 19

When would a Cystotomy be indicated?

Answer 19

In cases of bladder decompression if catheter cannot be placed via the urethra
To protect the urethra following injury/ surgery

Question 20

What suture patterns are used in a Cystotomy tube placement?

Answer 20

Purse string suture
Box suture
Roman-sandal suture

Question 21

How long do we keep a temporary cystotomy tube in?

Answer 21

at least one week to allow adhesion between bladder and abdominal wall

Question 22

In cases of Ureteral obstruction, what are the preferred surgical methods of treating it?

Answer 22

Ureterotomy (incision into the ureter)
Subcutaneous ureteral bypass system (bypasses the ureter and diverts urine from the kidney to the bladder)

Question 23

When would we perform surgery to treat Urinary Incontinence?

Answer 23

Only if medical interventions have failed and a specific diagnosis has been reached

Question 24

What procedures can be performed to treat USMI?

Answer 24

Bladder neck relocation/ urethral neck lengthening
Increasing urethral resistance

Question 25

How successful are surgical procedures aimed at fixing USMI?

Answer 25

Not very- 33-56% success

Question 26

What two ways can we increase urethral resistance to treat USMI and when are these indicated?

Answer 26

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