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Robin Small Animal Surgery I > Surgical Procedures: Repro & Urinary > Flashcards

Surgical Procedures: Repro & Urinary Flashcards

1
Q

SX:

Non functional Ovarian Cyst

A

**Surgical Excision is curative **

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2
Q

Functional Ovarian Cyst Surgery

A

**Surgical Excision is curative **

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3
Q

Ovarian Neoplasia Surgery

A

Solitary tumor: complete excision curative

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4
Q

Ovarian Remnant Syndrome Surgery

A

Surgical removal of remnant at the caudal pole of kidney

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5
Q

What is an ovariectomy(OVE)?

A

Removal of ovary alone. (OVE)

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6
Q

Pyometra Surgery

A

OVH

Because pyometra requires progesterone and the ovary is a source of progesterone.

Unilateral OVH preserves fertility

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7
Q

Cystic Endometrial Hyperplasia Surgery

A

OHE

Not a medical emergency. Good prognosis.

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8
Q

Pyometra Surgery

A

OHE after adequate resuscitation .

Large incision from xiphoid to pubis. 
No need to break suspensory ligament.
Milk purulent material away from cervix.
Ligate prior to clamp placement.
Use noncrushing clamps(Doyen).

Prognosis good with surgery.

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9
Q

Metritis Surgery

A

OHE is default. Does not affect milk production . Prognosis good with surgery.

Hysterotomy(incision into the urterus) preserves breeding. Only if the urterine wall is healthy.

Remove debris, lavage/suction to flush uterus.
Close with 3-0 or 4-0 absorbable monofilament. Do not penetrate mucosa.

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10
Q

Uterine Torsion Surgery

A

OHE - Treatment of Choice

Resuscitate first, remove viable pups by C-section.

Do not derotate.

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11
Q

Uterine Prolapse Surgery

A

OHE

Prevents recurrence. When manual reduction is not possible.

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12
Q

Dystocia Surgery

A

C-section(Hysterotomy):
Remove all fetuses, lavage uterus, close with 3-0 or 4-0 absorbable monofilament. Do one layer(continuous) or two(continuous and inverting layers). Use taper needle.

OR

Do En-bloc OHE:
Break down broad ligament, clamp pedicles without ligating, hand uterus off to non sterile assistant, remove puppies in

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13
Q

Nephrolithiasis Surgery

A

Nephrolithotomy - removal of stones from the kidney

Closure- sutureless
Hold for 5 minutes -> forms fibrin seal -> suture capsule only ->
release vascular clamp(clamp time 20 minutes) -> reattach
kidney

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14
Q

When is a pyelolithotomy indicated?

A

Used to remove calculi when proximal ureter and renal pelvis are dilated.

Does not require occlusion of blood supply and does not damage nephrons*

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15
Q

Renal Trauma Surgery

A

Moderate trauma: partial nephrectomy and omental patching

Major trauma: partial nephrectomy or nephroureterectomy(evaluate contralateral kidney first).

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16
Q

Indications for a Nephroureterectomy (removal or kidney and ureter).

A
  • Severe Infection
  • Severe Trauma
  • Obstructive Calculi with Persistent Hydronephrosis
  • Neoplasia
  • Transplant
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17
Q

Hydronephrosis Surgery

A

Nephroureterectomy if it is non functional kidney or there is severe parenchymal damage.

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18
Q

Pyelonephritis Surgery

A

Nephroureterectomy - if advanced

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19
Q

Giant Kidney Worm Surgery

A

Nephrectomy - removal of entire kidney

Or

Nephrotomy- incision made into the kidney to pull the worms out.

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20
Q

Renal Neoplasia Surgery

A

Nephroureterectomy - remove the kidney and ureter

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21
Q

Renal Transplants Surgery

A

Renal artery and vein anastomosis using 8/0 nylon

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22
Q

Ectopic Ureter Surgery

A

Ectopic Ureter:

Neoureterocystostomy (side to side) : intravesicular diversion for intramural ectopic ureter (the most common kind).

Neoureterocystostomy (end to side): reimplantation of ureter from extramural ectopic ureter. (Not as common)

OR

Cystoscopic Laser Treatment: intramural EU, similar success, decreased post op pain, cannot remove remnant ureter that may contribute to incontinence.

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23
Q

Surgery for Ureterocele: dilation of distal ureter

Types:
Intravesicular - normal location
Ectopic- abnormal location

A

Intravesicular- Ureterocelectomy

Ectopic- Neoureterocystostomy with ureterocelectomy

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24
Q

Urethral Trauma Surgery

A

*Nephroureterectomy: financial constraints, minimizes complications.

Or

*Ureteroureterostomy(urethral anastomosis): procedure of choice for proximal ureter b/c cannot re-implant.

Or

Neoureterocystostomy(urethral reimplantation)

Or

Urinary Diversion : urethral stent or nephrostomy tube.

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25
Q

Disadvantages of Ureteroureterostomy

A
  • Requires magnification
  • Extremely difficult
  • High incidence of complications: strictures and dehiscence.
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26
Q

Advantages of Ureteroureterostomy

A

Catheterize through cystotomy: avoids engaging back wall with suture.

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27
Q

What is a nephrostomy tube used for?

A

Urinary diversion: diverts urine after ureter surgery, hydronephrosis or obstruction.

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28
Q

What do we do when PROXIMAL uretheral length is insufficent to reach the bladder but long enough to cross midline?

A

Transureteroureterostomy:

Bring segment across midline and anastomosis to other ureter

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29
Q

What do you do when you have a significant loss of DISTAL ureter length?

A

Bladder Wall Flap:

Elevate bladder flap, implant ureter to end of flap and suture flap in a tube and close defect.

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30
Q

Ureterolithiasis Surgery

Most common indication for urethral surgery

A

Cystotomy and retrograde flushing and removal of stones via pyelithotomy.

Put in a permanent urethral stent to decrease morbidity, shorten hospital stay and have less complications.

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31
Q

The most common way to place a permanent urethral stent when treating ureterolithiasis.

A

Subcutaneous Urethral Bypass

Flow is from the kidney through the shunting port and into the bladder- bypassing the ureter.

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32
Q

Persistent Urachus Surgery

A

Surgical removal of urachal tube

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33
Q

Vesicouracheal Diverticulum Surgery

A

Partial cystectomy and diverticulectomy

34
Q

Urachal Cyst Surgery

A

Surgical Excision if clinical signs develop

35
Q

Urachal Sinus Surgery

A

Surgical excision

36
Q

Bladder Rupture Surgery

A

Repair immediately if stable

Urinary diversion: urethral catheter, tube cystotomy(cystopexy- moves the bladder to the right spot using 2 lines of suture)

Exploratory laparotomy

Cystectomy- deride tear and necrotic tissue close to bladder wall

Omentalize patching

Catheterize urethra to keep bladder empty

37
Q

Cystic Calculi Surgery

A

Most common reason to do a CYSTOTOMY(opening in the bladder to remove calculi)

Most common surgery of the bladder. Ventral approach preferred because there is increased exposure of the bladder neck and you can visualize ureteral orifices.

Empty the bladder

Males: drape prepuce in field.

Always use stay sutures. (Less traumatic way to handle the bladder)

38
Q

Layer of strength when closing the bladder during a cystotomy.

A

Submucosa is the layer of strength

39
Q

What suture material do you use during a cystotomy?

A

3-0 PDS small

40
Q

What suture patterns do you use when closing a cystotomy?

A

One or two layer inverting pattern in a normal bladder

41
Q

What is Lithotripsy?

A

Shock waves to break up stones.

42
Q

Polypoid Cystitis Surgery

A

Resection

43
Q

Bladder Tumors Surgery

A

Partial cystectomy with >1cm borders

44
Q

Surgery for Hypospadias: incomplete formation of penile urethra

A

If no signs- do nothing

If signs- do reconstruction

45
Q

Urethral Prolapse Surgery

A

Asymptomatic: reduce with aid of large catheter, place purse string suture and leave for 5 days.

Symptomatic: resection and anastomosis AND urethropexy(moving the urethra to the right place).

46
Q

Urethral Obstruction Surgery

A

Cystotomy after hydropropulsion.

Urethrotomy if hydropropulsion unsuccessful.

Cystotomy + Urethrotomy often performed

Urethrostomy(opening in the urethra)-prevent reoccurrence if medial prevention is not possible.

47
Q

Where should a urethrotomy in a dog be performed?

A

Prescrotal: common obstruction area, superficial, less cavernous tissue. Heal by second intention because less risk of stricture. HOWEVER, can cause profuse hemorrhage and hospitalization.

AVOID perineal because there is an increase risk of infection and a more difficult procedure.

48
Q

Why would a urethroStomy be performed?

Surgical formation of a permanent opening of the urethra at a new site.

A

Indications:

  • permanent damage to the distal urethra
  • recurrent urethral obstruction
  • obstruction that cannot be retropulsed or removed by urethrotomy.
49
Q

Preferred site of urethroStomy in the dog.

A

Scrotal

Drap abdomen, scrotum and prepuce

Make 2.5-4cm midline incision.

Accurately appose skin and mucosa.

50
Q

Preferred site of urethroStomy in the cat.

A

Perineal

Frequent obstruction, strictures and trauma. Failed attempts at medical management.

51
Q

Why dont we do a prescrotal urethroStomy in the dog?

A

Higher incidence of urine scald.

52
Q

Goals of urethroStomy.

A
  • Adequate mobilization of urethra
  • Preserve urethral branches with minimal dorsal dissection
  • Creation of a wide urethral orifice
53
Q

How do we ensure adequate width of urethra during a perineal urethroStomy?

A

Use mosquito forceps to hinge then manually express bladder for leakage.

54
Q

Urethral Trauma Surgery

A

Incomplete or small lacerations- heal with urinary diversion with urethral catheter(increases stricture formation) or cystostomy tube.

Complete rupture requires anastomosis or repair with urinary diversion.

55
Q

Urethral Stictures Surgery

A 
If signs:
Urethral dilators
Balloon dilation
Resection and anastomosis
Proximal urethoStomy.
56
Q

Surgery for Vestibulovaginal Stenosis- Septal lesion

A

Episiotomy

Or

Endoscopic Treatment: laser ablation and endoscopic scissor resection.

57
Q

Surgery for V-v stenosis: Annular Lesion

A

Caudal to pelvis- vaginal resection and anastomosis

Intrapelvic- vaginectomy(cervix to urethral opening) - include OHE if not already spayed.

58
Q

Recessed Vulva Surgery

A

Episioplasty aka Vulvoplasty

59
Q

Vaginal Edema/ Hyperplasia Surgery

A

OHE/OVE resolves and prevents recurrence

-Resection of tissue: if there is significant mucosal injury, if its a breeding animal. Episiotomy likely required.

60
Q

Vaginal Prolapse Surgery

A

Manual reduction + OHE

61
Q

Neoplasia Surgery

A

Benign: aggressive resection

Malignancy: Vulvovaginectomy. Also requires perineal urethrostomy.

62
Q

Canine Mammary Tumor:

In what situation would be do a lumpectomy?

A

Lumpectomy :

-removal of solitary mass(small

63
Q

Canine Mammary Tumor:

In what situation would be do a Simple Mastectomy?

A
  • Solitary mass 1-2 cm within gland
  • Do not do if multiple COM, large(>2cm)mass or if 2-3 cm margin invades additional glands

Margins: 2-3 cm around mass

64
Q

Canine Mammary Tumor:

In what situation would you do a regional mastectomy?

A
  • Multiple tumors in adjacent glands
  • Remove glands 1-3 in tumors are in glands 1 and 2
  • Remove glands 3-5(and superficial inguinal LN)if tumors are in glands 4 and 5
65
Q

Canine Mammary Tumor:

When would you do a chain mastectomy?

A

If tumor is in gland 3 with any COM and simple mastectomy is not indicated.

  • multiple masses throughout chaun
  • solitary mass anywhere with multiple COM
66
Q

Inflammatory Carcinoma Surgery

A

Surgery NOT recommended because it is rapidly progressive and the MST is

67
Q

Feline Mammary Tumors Surgery

A

Chain mastectomy on affected side regardless of tumor size and number

68
Q

Fibroadenomatous Hyperplasia Surgery

A

OVE/ OHE- flank approach because boobies are huge and inflamed.

69
Q

Cryptorchidism Surgery

A

Remove abnormal testicle first

70
Q

Testicular Torsion Surgery

A

Castration
Fatal without surgical treatment
Prognosis good with surgery
Do not derotate.

71
Q

Testicular Neoplasia Surgery

A

Bilateral castration with scrotal ablation

72
Q

What surgery does not effect testosterone , and ONLY affects fertility?

A

Vasectomy

73
Q

Surgery for Hypospadias: incomplete formation of the penile urethra

A

UrethroStomy proximal to abnormality

74
Q

Paraphimosis surgery

A

Surgery indicated when it is a recurrent condition, small diameter preputial opening and necrosis present.

Surgery:
Congential: enlarge orifice, advance prepuce and partial penile amputation may be necessary

Acquired: tx underlying cause, castration if intact, phallopexy if persistent and penile amputation if necrosis present.

75
Q

Penis Trauma/Neoplasia surgery

A

Penile Amputation

76
Q

Prepuce Trauma/ Neoplasia surgery

A

Preputial reconstruction

77
Q

BPH surgery

A

Castration

78
Q

Prostatic Abscess/Prostatitis surgery

A

Mild case: antibiotics, fluid and castration

Severe cases exploratory laparotomy and omentalization + castration

79
Q

Prostatic Cysts surgery

A

Small: resection
Large: partial resection and omentalization
Any: castration

80
Q

Prostatic Neoplasia surgery

A

Treatment not usually pursued

Curative intent for small / early lesions only: partial or complete prostatectomy combined with radiation

Pallative: tube cystostomy or urethral stent

Robin Small Animal Surgery I (5 decks)

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