Urinary - Kidneys And Ureters Flashcards
What is the anatomical significance of the inner medulla of the kidney with regard to surgical approach?
Inner medulla:
- collecting ducts
- renal pelvis*
*location of Renal a., v., and ureter;
It’s NOT uncommon when the renal a. enters at the renal pelvis to bi-or-TRI-furcate—> need to ligate those multiple aa. OR ligate more proximal to those aa.
If we must make an incision on the kidney, what do we need to keep in mind and where do we cut?
When blood supply hits the kidney, it DOESN’T cross the sagittal plane - so we want to make the incisions here to minimize hemorrhage
If you’re performing a nephroureterectomy in an INTACT patient, what do we need to be mindful of?
If we’re removing the LEFT kidney, remember that the left ovarian/ left testicular vein come off of the left renal vein —> we need to preserve the venous supply by ligating CLOSER TO the kidney!
Term we use for cutting into the kidney parenchyma itself…
Nephrotomy
Term we use for making a surgical incision into the renal pelvis area…
Pyelolithotomy
What is a nephrostomy tube?
Tube from the kidney to the external env’t
If you plan to remove stones via nephrolithotomy, what is IMPERATIVE to do?
Check CONTRALATERAL renal function!
- GFR
- excretory urography
BECAUSE: every time you do surgery, you run the risk of damaging the ipsilateral/affected kidney
Concerning nephrolithotomy, once we remove the stone(s) and submit for culture/sensitivity/analysis, and culture the renal pelvis, what do we need to do to try and minimize the chance of clot formation?
Flush renal pelvis with heparinized saline to make sure the ureter is patent going all the way to the bladder!
*clot formation in the renal pelvis will lead to hydronephrosis
How long is vascular clamp time before we start to see renal damage in the case of nephrolithotomy?
20 min!
When would a pyelolithotomy be a better choice than a nephrolithotomy to remove kidney stones?
When calculi in renal pelvis is present and the pelvis is dilated and if the stone isn’t deep into the parenchyma
no vascular occlusion and no damage to functional renal tissue (nephrons)
In the case of hydronephrosis by obstruction, what is the time frame for complete resolution? Otherwise?
<1 week obstruction—>complete resolution
> 4 week obstruction—> MAY regain 25% :(
What is the most common renal neoplasia in the dog?
Renal cell carcinoma
increased incidence in males, with age
What is the treatment for Renal Cell Carcinoma?
Nephroureterectomy and chemotherapy
What’s the most common renal neoplasia in the cat?
Renal lymphoma - surgery usually not indicated
In screening for renal transplant patients, what do we require for them to qualify?
PCV>30%
Crea <8 mg/dL
BUN <100 mg/dL
otherwise, need EPO, fluids, etc. to get them to acceptable levels
When do we treat renal transplant patients with immunosuppression therapy?
24-72 hours PRIOR to surgery, continued after surgery…
Term for transplanting the distal ureter into a new place in the bladder?
Neoureterocystostomy
Term for transplanting the ureter into another place (bladder, urethra, etc)?
Neoureterostomy
Term for cutting into the ureter?
Ureterotomy
Term for resection/anastomosis of ureter?
Ureteroereterosotomy
What are the most common abnormalities associated with an ectopic ureter?
Hydroureter
Small/absent kidney
Pelvic bladder
What is the most common signalment/clinical signs associated with ectopic ureters?
Siberian huskies, labs, golden retrievers, WHWT
CS: young 6-8 week old puppy that is dribbling urine; consistent incontinence and dermatitis (urine scald)
How do we determine the extent of ureteral damage?
Observe for urine leakage - if present, need to intervene
As far as performing a resection anastomosis of the ureter, what is the procedure of choice for injury the proximal ureter and why?
Ureteroureterostomy;
because at the level of the proximal ureter, you don’t have enough ureteral length to re-transplant that ureter into the bladder
What is the purpose of a urinary diversion procedure in the treatment of ureteral trauma?
To help minimize the amount of urine that is flowing across that anastomosis site (which would cause urine leakage/potential dehiscence)
In regards to medical management, what are reasonable choices in dealing with ureterolithiasis?
*IV fluids + diuretics
=increase flow in the hopes of moving the stone(s) to the bladder
*smooth muscle relaxers: glucagon, amillotriptoline?
What are ureterolithiasis indications for surgery/lithotripsy?
Complete obstruction
Azotemia
Pyelonephritis
After 2 weeks of unsuccessful medical management
With regard to presurgical considerations for ureterolithiasis, what pre-existing pathology do most cats have, unrelated to obstruction?
Interstitial nephritis
What is lithotripsy?
Using shockwaves (basically) to make stones smaller (Non-surgical)
*not always effective
