Unit 3 - Urinary

Question 1

Where are uroliths most likely to localize?

Answer 1

Sigmoid flexure, trigone of the bladder, and urethral process

Question 2

You have a red urine sample. How do you differentiate if the cause is RBC, myoglobin, and hemoglobin?

Answer 2

If you spin it down and it pellets and the rest of the urine is clear it is RBC.

If you spin it down and it is still red, then it is either myoglobin or hemoglobin. To differentiate between the two, spin some blood down in a PCV tube. If the serum is red then it is due hemoglobin. If it is clear then it is due to myoglobin.

Question 3

Where do both kidneys lay?

Answer 3

On the right side - the right is under the last rib, the left is further caudal

Question 4

What does the bovine kidney look like?

Answer 4

It is multi-lobulated

Question 5

What can cause sheath swelling?

Answer 5

Water belly
Retroprepucial abscess
Penile hematoma

Question 6

What is water belly?

Answer 6

Obstructive urolithiasis

Question 7

How do cattle present with waterbelly?

Answer 7

Dripping from the prepuce
Pitting edema
Don’t feel well

Question 8

How do goats present with waterbelly?

Answer 8

Sawhorse stance
Grinding teeth
Urethralis muscle is pulsating
Showing signs of colic

Question 9

What can be a predisposing factor to urolithiasis?

Answer 9

Male anatomy
Age of castration and urethral diameter
Breed
Amount of water intake

Question 10

How can age of castration affect the size of the urethral diameter?

Answer 10

If they are castrated too soon, the diameter is likely not as large as it can be

Question 11

What nutritional management can effect stone composition?

Answer 11

Ca:P balance
Grain intake
Roughage source

Question 12

What types of stones can ruminants get?

Answer 12

Struvite
Amorphus Mg Ca Phosphate
Ca phosphate
Ca carbonate
Ca oxalate
Silicates

Question 13

What is the ideal nutritional makeup for goats?

Answer 13

High roughage with minimal to no concentrate
Desirable Ca:P
Lots of rumination, excretion of phosphorus in saliva

Question 14

What may you see on CBC and chemistry in urolithiasis patients?

Answer 14

Stress leukogram to left shift
Azotemia
Hypophosphatemia to hyperphosphatemia
Hyponatremia, hypochloremia
Hyperkalemia possible, but not necessarily present in call cases

Question 15

What drugs should be on board for the urethral process amputation?

Answer 15

Either sedation (midazolam/diazepam, acepromazine, opioid) or an epidural (lumbosacral)

Question 16

What medical therapy is recommended for urolithiasis treatment?

Answer 16

Judicious fluid therapy to correct electrolyte imbalances
Anxiolytics and pain control
Urine acidification (6-6.5)

Question 17

How is Walpole’s (acetic acid) solution used for treatment of urolithiasis?

Answer 17

A cystocentesis is done and the bladder is infused with an acidic solution to acidify the urine (pH 5) and dissolve struvite stones.
Place a tanscutaneous pig-tail catheter
Be careful with repeated use - if you are going to open the bladder don’t o it

Question 18

What are some long-term options for urolithiasis treatment?

Answer 18

Tube cystostomy
Ischial urethrostomy in breeding bulls
Bladder marsupialization
Vesiculopreputial anastomosis

Question 19

What are some salvage procedures for treatment of urolithiasis?

Answer 19

Penile amputation
Urethrostomy
Urethrotomy at site of obstruction

Question 20

What is the gold standard treatment for urolithiasis?

Answer 20

Tube cystostomy

Question 21

What males can a tube cystostomy be done in?

Answer 21

Breeding rams and bucks

Question 22

What is a tube cystostomy?

Answer 22

Diversion of urine via a Foley catheter to allow the urethra to heal

Question 23

How many days post operative does a tube cystostomy patient need to have in hospital?

Answer 23

5-7 days

Question 24

How is a tube cystostomy done?

Answer 24

Make a paramedian incision next to the penis,
Exteriorize the bladder
Make a stab incision into the bladder
Empty the bladder
Scoop out the stones
Close the bladder with an inverting absorbable suture (2-layer)
Place foley catheter through the body wall via a second paramedian incision and placed into the bladder.
The foley catheter is filled with saline and the catheter is finger trapped to the skin

Question 25

What is bladder marsupialization?

Answer 25

Creating a permanent stoma of the bladder to the body wall itself

Question 26

What is the biggest concern with bladder marsupialization?

Answer 26

Urine scald

Question 27

What population is an ischial urethrostomy done in?

Answer 27

Breeding bulls

Question 28

How is an ischial urethrostomy done?

Answer 28

Epidural anesthesia
Cut at the level of the ischium down to the level (stay midline) of the urethra.
Cut into the urethra and place a foley catheter

Question 29

How does the urethra heal after an ischial urethrostomy?

Answer 29

By second intention

Question 30

How is a penile amputation done?

Answer 30

Cut around the area of the sigmoid flexure.
Transect the penis at this level and just leave it in its sheath.
Suture the proximal portion of the penis with mattress sutures to the body wall.
Make sure to not suture the urethra
Suture the dorsal and ventral edges of the incision closed.

Question 31

What post op management is recommended for urethrostomies?

Answer 31

Fluid therapy
Antibiotics
Pain control
Urine acidification
Diet and management changes

Question 32

What is the most common urinary disease in cattle?

Answer 32

Pyelonephritis

Question 33

What etiologic agents are commonly isolated in patients with pyelonephritis?

Answer 33

Corynebacterium
T. pyogenes
E. coli

Question 34

What are the risk factors for pyelonephritis?

Answer 34

Dystocia, bladder paralysis

Question 35

What CS are for pyelonephritis?

Answer 35

Variable fever, ADR, abnormal urination (hematuria, pyuria, abnormal color)

Question 36

How is pyelonephritis treated?

Answer 36

Beta-lactams - PPG ceftiofur
Urine culture and sensitivity
Nephrectomy
Euthanasia if bilateral