Surgical Procedures: Repro & Urinary Flashcards
SX:
Non functional Ovarian Cyst
**Surgical Excision is curative **
Functional Ovarian Cyst Surgery
**Surgical Excision is curative **
Ovarian Neoplasia Surgery
Solitary tumor: complete excision curative
Ovarian Remnant Syndrome Surgery
Surgical removal of remnant at the caudal pole of kidney
What is an ovariectomy(OVE)?
Removal of ovary alone. (OVE)
Pyometra Surgery
OVH
Because pyometra requires progesterone and the ovary is a source of progesterone.
Unilateral OVH preserves fertility
Cystic Endometrial Hyperplasia Surgery
OHE
Not a medical emergency. Good prognosis.
Pyometra Surgery
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.
Metritis Surgery
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.
Uterine Torsion Surgery
OHE - Treatment of Choice
Resuscitate first, remove viable pups by C-section.
Do not derotate.
Uterine Prolapse Surgery
OHE
Prevents recurrence. When manual reduction is not possible.
Dystocia Surgery
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
Nephrolithiasis Surgery
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
When is a pyelolithotomy indicated?
Used to remove calculi when proximal ureter and renal pelvis are dilated.
Does not require occlusion of blood supply and does not damage nephrons*
Renal Trauma Surgery
Moderate trauma: partial nephrectomy and omental patching
Major trauma: partial nephrectomy or nephroureterectomy(evaluate contralateral kidney first).
Indications for a Nephroureterectomy (removal or kidney and ureter).
- Severe Infection
- Severe Trauma
- Obstructive Calculi with Persistent Hydronephrosis
- Neoplasia
- Transplant
Hydronephrosis Surgery
Nephroureterectomy if it is non functional kidney or there is severe parenchymal damage.
Pyelonephritis Surgery
Nephroureterectomy - if advanced
Giant Kidney Worm Surgery
Nephrectomy - removal of entire kidney
Or
Nephrotomy- incision made into the kidney to pull the worms out.
Renal Neoplasia Surgery
Nephroureterectomy - remove the kidney and ureter
Renal Transplants Surgery
Renal artery and vein anastomosis using 8/0 nylon
Ectopic Ureter Surgery
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.
Surgery for Ureterocele: dilation of distal ureter
Types:
Intravesicular - normal location
Ectopic- abnormal location
Intravesicular- Ureterocelectomy
Ectopic- Neoureterocystostomy with ureterocelectomy
Urethral Trauma Surgery
*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.
Disadvantages of Ureteroureterostomy
- Requires magnification
- Extremely difficult
- High incidence of complications: strictures and dehiscence.
Advantages of Ureteroureterostomy
Catheterize through cystotomy: avoids engaging back wall with suture.
What is a nephrostomy tube used for?
Urinary diversion: diverts urine after ureter surgery, hydronephrosis or obstruction.
What do we do when PROXIMAL uretheral length is insufficent to reach the bladder but long enough to cross midline?
Transureteroureterostomy:
Bring segment across midline and anastomosis to other ureter
What do you do when you have a significant loss of DISTAL ureter length?
Bladder Wall Flap:
Elevate bladder flap, implant ureter to end of flap and suture flap in a tube and close defect.
Ureterolithiasis Surgery
Most common indication for urethral surgery
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.
The most common way to place a permanent urethral stent when treating ureterolithiasis.
Subcutaneous Urethral Bypass
Flow is from the kidney through the shunting port and into the bladder- bypassing the ureter.
Persistent Urachus Surgery
Surgical removal of urachal tube
Vesicouracheal Diverticulum Surgery
Partial cystectomy and diverticulectomy
Urachal Cyst Surgery
Surgical Excision if clinical signs develop
Urachal Sinus Surgery
Surgical excision
Bladder Rupture Surgery
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
Cystic Calculi Surgery
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)
Layer of strength when closing the bladder during a cystotomy.
Submucosa is the layer of strength
What suture material do you use during a cystotomy?
3-0 PDS small
What suture patterns do you use when closing a cystotomy?
One or two layer inverting pattern in a normal bladder
What is Lithotripsy?
Shock waves to break up stones.
Polypoid Cystitis Surgery
Resection
Bladder Tumors Surgery
Partial cystectomy with >1cm borders
Surgery for Hypospadias: incomplete formation of penile urethra
If no signs- do nothing
If signs- do reconstruction
Urethral Prolapse Surgery
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).
Urethral Obstruction Surgery
Cystotomy after hydropropulsion.
Urethrotomy if hydropropulsion unsuccessful.
Cystotomy + Urethrotomy often performed
Urethrostomy(opening in the urethra)-prevent reoccurrence if medial prevention is not possible.
Where should a urethrotomy in a dog be performed?
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.
Why would a urethroStomy be performed?
Surgical formation of a permanent opening of the urethra at a new site.
Indications:
- permanent damage to the distal urethra
- recurrent urethral obstruction
- obstruction that cannot be retropulsed or removed by urethrotomy.
Preferred site of urethroStomy in the dog.
Scrotal
Drap abdomen, scrotum and prepuce
Make 2.5-4cm midline incision.
Accurately appose skin and mucosa.
Preferred site of urethroStomy in the cat.
Perineal
Frequent obstruction, strictures and trauma. Failed attempts at medical management.
Why dont we do a prescrotal urethroStomy in the dog?
Higher incidence of urine scald.
Goals of urethroStomy.
- Adequate mobilization of urethra
- Preserve urethral branches with minimal dorsal dissection
- Creation of a wide urethral orifice
How do we ensure adequate width of urethra during a perineal urethroStomy?
Use mosquito forceps to hinge then manually express bladder for leakage.
Urethral Trauma Surgery
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.
Urethral Stictures Surgery
If signs: Urethral dilators Balloon dilation Resection and anastomosis Proximal urethoStomy.
Surgery for Vestibulovaginal Stenosis- Septal lesion
Episiotomy
Or
Endoscopic Treatment: laser ablation and endoscopic scissor resection.
Surgery for V-v stenosis: Annular Lesion
Caudal to pelvis- vaginal resection and anastomosis
Intrapelvic- vaginectomy(cervix to urethral opening) - include OHE if not already spayed.
Recessed Vulva Surgery
Episioplasty aka Vulvoplasty
Vaginal Edema/ Hyperplasia Surgery
OHE/OVE resolves and prevents recurrence
-Resection of tissue: if there is significant mucosal injury, if its a breeding animal. Episiotomy likely required.
Vaginal Prolapse Surgery
Manual reduction + OHE
Neoplasia Surgery
Benign: aggressive resection
Malignancy: Vulvovaginectomy. Also requires perineal urethrostomy.
Canine Mammary Tumor:
In what situation would be do a lumpectomy?
Lumpectomy :
-removal of solitary mass(small
Canine Mammary Tumor:
In what situation would be do a Simple Mastectomy?
- 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
Canine Mammary Tumor:
In what situation would you do a regional mastectomy?
- 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
Canine Mammary Tumor:
When would you do a chain mastectomy?
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
Inflammatory Carcinoma Surgery
Surgery NOT recommended because it is rapidly progressive and the MST is
Feline Mammary Tumors Surgery
Chain mastectomy on affected side regardless of tumor size and number
Fibroadenomatous Hyperplasia Surgery
OVE/ OHE- flank approach because boobies are huge and inflamed.
Cryptorchidism Surgery
Remove abnormal testicle first
Testicular Torsion Surgery
Castration
Fatal without surgical treatment
Prognosis good with surgery
Do not derotate.
Testicular Neoplasia Surgery
Bilateral castration with scrotal ablation
What surgery does not effect testosterone , and ONLY affects fertility?
Vasectomy
Surgery for Hypospadias: incomplete formation of the penile urethra
UrethroStomy proximal to abnormality
Paraphimosis surgery
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.
Penis Trauma/Neoplasia surgery
Penile Amputation
Prepuce Trauma/ Neoplasia surgery
Preputial reconstruction
BPH surgery
Castration
Prostatic Abscess/Prostatitis surgery
Mild case: antibiotics, fluid and castration
Severe cases exploratory laparotomy and omentalization + castration
Prostatic Cysts surgery
Small: resection
Large: partial resection and omentalization
Any: castration
Prostatic Neoplasia surgery
Treatment not usually pursued
Curative intent for small / early lesions only: partial or complete prostatectomy combined with radiation
Pallative: tube cystostomy or urethral stent
