Urinary - surgery Flashcards
What are the 3 most common surgical renal diseases?
Neoplasia
Renal calculi
Hydronephrosis
What are the 3 most common renal surgery procedures?
Ureteronephrectomy
Renal biopsy
Nephrotomy
What are the methods of renal biopsy samples?
Ultrasound guided
Laparoscopic
Surgical
FNA/Tru-cut/incisional biopsy
What are the different types of renal neoplasia?
Lymphoma
Renal cell carcinoma
Transitional cell carcinoma
What is a ureteronephrectomy?
Removal of kidney and ureter (double ligated at bladder neck)
What is the most common renolith/renal calculi?
Calcium oxalate
How do you treat renoliths?
Nothing - often dont need treating
Surgery - nephrotomy (not really done tho)
If they are obstructive or causing UTI/haematuria
What are the most common ureteric surgical diseases?
Urethral trauma
Urethral calculi
Urethral neoplasia
Ectopic ureter
How do you treat ureteric calculi?
Diuresis
Lithotripsy
Surgery - subcutaneous ureteral bypass or ureteral stent
What is the prognosis of ureteral surgery?
High complication rate
What are the causes of hydronephrosis?
Pyelonephritis
Obstruction
Congenital stenosis
What is the treatment for hydronephrosis?
Ureteronephrectomy
What is the presentation of ectopic ureters?
Young dogs
PUPD
Urinary incontinence - dribbling
UTI common
What is the best diagnostic technique to diagnose ectopic ureter?
CT
What are the 2 types of ectopic ureter?
Intramural - runs submucosally in bladder wall before opening into urethra (more common)
Extramural - completely bypasses the bladder (less common, much harder to treat)
What are the different surgical treatments for ectopic ureter?
Lase ablation - for intramural in females
Neoureterostomy - for intramural in males
Ureteroneocystostomy - for extramural
What are the 3 surgical bladder diseases?
Bladder calculi
Bladder rupture
Bladder neoplasia
What are the different surgical procedures?
Bladder biopsy
Cystotomy
Cystectomy
Cystostomy
Cystopexy
What is the only type of calculi that can be dissolved?
Struvite
What is the main surgical treatment for cystoliths in first opinion?
Cystotomy
How do you perform a simple cystotomy?
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
What are the complications of cystotomy?
Residual calculi
Uroabdomen
Suture-associated calculogenesis
Haematuria/dysuria
What is the main surgical disease of the urethra?
Canine/feline urethral obstruction
What are the treatments for urethral obstruction?
Urethrostomy - make male pee through perineum/scrotum like female (for recurrent obstruction)
Retrohydropropulsion - to avoid urethral surgery
How do you do retrohydropropulsion of the urethra?
Compress pelvic urethra (easier with two people)
Increase pressure through syringe to dilate urethra
Then release pressure to push stones back into bladder
What is atonic bladder? How do you treat it?
Dysuria due to bladder muscle overdistension
Treat with detrusor stimulants and urethral relaxant
Avoid bladder filling for 4-6 weeks
What is the most common type of bladder neoplasia?
Transitional cell carcinoma
How can you treat bladder neoplasia?
Medical - chemo, NSAIDs
Surgery - for benign only
Surgical and medical - cystectomy, can be better survival
Palliative - diversion, stenting (stops blockage)
What are the indications for cystectomy (can remove up to 70% of bladder)?
Polypoid cystitis - curative
Necrotic bladder
Early neoplastic lesions
What is a tube cystostomy?
Diverts urine away from the urethra - down separate catheter out of body wall
How do you do a tube cystostomy?
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
How can you diagnose urinary tract rupture?
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
How do you treat a bladder rupture?
Stabilise
Ex lap - methodical 4 quadrant check
Debride damaged bladder
Suture closed as for cystotomy
Omentalise
Flush abdomen - warm saline, suction
How do you treat urethral rupture?
Repair - chance of stricture formation
Bypass urethra - tube cystostomy, indwelling urethral catheter
What is a cystopexy?
Secure bladder to abdominal wall - stop herneation
