Urinary - surgery

Question 1

What are the 3 most common surgical renal diseases?

Answer 1

Neoplasia
Renal calculi
Hydronephrosis

Question 2

What are the 3 most common renal surgery procedures?

Answer 2

Ureteronephrectomy
Renal biopsy
Nephrotomy

Question 3

What are the methods of renal biopsy samples?

Answer 3

Ultrasound guided
Laparoscopic
Surgical
FNA/Tru-cut/incisional biopsy

Question 4

What are the different types of renal neoplasia?

Answer 4

Lymphoma
Renal cell carcinoma
Transitional cell carcinoma

Question 5

What is a ureteronephrectomy?

Answer 5

Removal of kidney and ureter (double ligated at bladder neck)

Question 6

What is the most common renolith/renal calculi?

Answer 6

Calcium oxalate

Question 7

How do you treat renoliths?

Answer 7

Nothing - often dont need treating
Surgery - nephrotomy (not really done tho)
If they are obstructive or causing UTI/haematuria

Question 8

What are the most common ureteric surgical diseases?

Answer 8

Urethral trauma
Urethral calculi
Urethral neoplasia
Ectopic ureter

Question 9

How do you treat ureteric calculi?

Answer 9

Diuresis
Lithotripsy
Surgery - subcutaneous ureteral bypass or ureteral stent

Question 10

What is the prognosis of ureteral surgery?

Answer 10

High complication rate

Question 11

What are the causes of hydronephrosis?

Answer 11

Pyelonephritis
Obstruction
Congenital stenosis

Question 12

What is the treatment for hydronephrosis?

Answer 12

Ureteronephrectomy

Question 13

What is the presentation of ectopic ureters?

Answer 13

Young dogs
PUPD
Urinary incontinence - dribbling
UTI common

Question 14

What is the best diagnostic technique to diagnose ectopic ureter?

Answer 14

CT

Question 15

What are the 2 types of ectopic ureter?

Answer 15

Intramural - runs submucosally in bladder wall before opening into urethra (more common)
Extramural - completely bypasses the bladder (less common, much harder to treat)

Question 16

What are the different surgical treatments for ectopic ureter?

Answer 16

Lase ablation - for intramural in females
Neoureterostomy - for intramural in males
Ureteroneocystostomy - for extramural

Question 17

What are the 3 surgical bladder diseases?

Answer 17

Bladder calculi
Bladder rupture
Bladder neoplasia

Question 18

What are the different surgical procedures?

Answer 18

Bladder biopsy
Cystotomy
Cystectomy
Cystostomy
Cystopexy

Question 19

What is the only type of calculi that can be dissolved?

Answer 19

Struvite

Question 20

What is the main surgical treatment for cystoliths in first opinion?

Answer 20

Cystotomy

Question 21

How do you perform a simple cystotomy?

Answer 21

Caudal midline laparotomy
Exteriorise bladder and pack off the abdomen
Stay sutures into bladder apex
Stab incision
Remove calculi
Close bladder
Omentalise
Close abdomen
Radiograph

Question 22

What are the complications of cystotomy?

Answer 22

Residual calculi
Uroabdomen
Suture-associated calculogenesis
Haematuria/dysuria

Question 23

What is the main surgical disease of the urethra?

Answer 23

Canine/feline urethral obstruction

Question 24

What are the treatments for urethral obstruction?

Answer 24

Urethrostomy - make male pee through perineum/scrotum like female (for recurrent obstruction)
Retrohydropropulsion - to avoid urethral surgery

Question 25

How do you do retrohydropropulsion of the urethra?

Answer 25

Compress pelvic urethra (easier with two people) Increase pressure through syringe to dilate urethra Then release pressure to push stones back into bladder

Question 26

What is atonic bladder? How do you treat it?

Answer 26

Dysuria due to bladder muscle overdistension Treat with detrusor stimulants and urethral relaxant Avoid bladder filling for 4-6 weeks

Question 27

What is the most common type of bladder neoplasia?

Answer 27

Transitional cell carcinoma

Question 28

How can you treat bladder neoplasia?

Answer 28

Medical - chemo, NSAIDs Surgery - for benign only Surgical and medical - cystectomy, can be better survival Palliative - diversion, stenting (stops blockage)

Question 29

What are the indications for cystectomy (can remove up to 70% of bladder)?

Answer 29

Polypoid cystitis - curative Necrotic bladder Early neoplastic lesions

Question 30

What is a tube cystostomy?

Answer 30

Diverts urine away from the urethra - down separate catheter out of body wall

Question 31

How do you do a tube cystostomy?

Answer 31

Do laparotomy Foley catheter through stab incision in body wall adjacent to bladder Purse string suture Stab incision into bladder centre and foley catheter pushed through Purse string suture Suture bladder to body wall Then close laparotomy incision Foley catheter attached to external skin with tape and help in place with vest

Question 32

How can you diagnose urinary tract rupture?

Answer 32

Rising plasma urea creatinine levels on bloods Or uroabdomen - level of urea creatinine compared to blood Intravenous urethrogram - best for identifying ruptures of kidney and ureter

Question 33

How do you treat a bladder rupture?

Answer 33

Stabilise Ex lap - methodical 4 quadrant check Debride damaged bladder Suture closed as for cystotomy Omentalise Flush abdomen - warm saline, suction

Question 34

How do you treat urethral rupture?

Answer 34

Repair - chance of stricture formation Bypass urethra - tube cystostomy, indwelling urethral catheter

Question 35

What is a cystopexy?

Answer 35

Secure bladder to abdominal wall - stop herneation