urinary sx Flashcards
What important anatomic things do we have to know?
- obviously the kidneys lmao
- renal artery and vein
- cranial ureteral artery
- deep circumflex iliac artery and vein (can see artery? on rads)
- bladder and ureter lmao
tell me what we have to know about renal abscesses
- they are rare in dogs.
- can come about from pyelonephritis, nephrolithiasis, renal biopsy, DM, and hyperadrenocorticism
- U/S, CT, cytology of fluid, bac t culture
- supportive care and abx, ureteral stent or sub, nephrectomy
basically, they’re rare in dogs and im not gonna know anything past that lmao
tell me what we have to know for kidney trauma
- hard to diagnose, based on history
- C/S –> gross or microscopic hematuria, pain on palpation, hemoabdomen, uroabdomen, renal herniations through body wall
true or false: in the kidneys, primary malignant tumors are common, and mets to the kidney are rare. why or why not?
false!! primary malignant tumors are RARE, most common is METASTATIC DISEASE
lots of cardiac output that goes to kidney, lots of flow and filtration in kidney where cancer cells get stuck
what are the most common primary kidney tumor types on dogs and cats?
dogs: renal carcinoma
cats: lymphoma
what are the 2 kidney tumors types that we have to know (hint: not lymphoma or renal carcinoma)
- nephroblastoma –> young to middle aged dogs, can happen in lots of parts of body
- renal cystadenocarcinoma –> GSDs, rare, inherited
what are the C/S of renal neoplasia?
persistent hematuria, weight loss, lethargy, inappetence, UTIs, palpable abdominal mass
how do you dx kidney neoplasia?
CBC/Chem/UA, abdominal rads, CT, US, aspirate
unilateral ureter tears can be hard to diagnose if urine accumulation is ______.
retroperitoneal
why is it hard to diagnose unilateral ureter tears from trauma?
harder if retroperitoneal, easier if peritoneal
C/S are vague, blood work may be normal systemically esp if unilateral
ureters are _______ (tolerant/not tolerant) of surgery. This makes repair of ureter tears ______ (easy/hard).
not tolerant
hard
what is the most common neoplasia of the ureters?
transitional cell carcinoma
often an extension of a bladder mass
what is the most common cause of uroabdomen/uroperitoneum?
traumatic rupture of urinary bladder
happens for many reasons: HBC, falling from height, aggressive catheterization of bladder
urine leakage into abdomen causes _____, _____, and _____.
azotemia, dehydration, hypovolemia
how do you diagnose uroabdomen in a patient you suspect has one (from fluid wave in abdomen, hx of trauma)
- abdominal fluid creatinine compared to peripheral blood (abdomen > peripheral = uroabdomen)
- abdominal rads (loss of serial detail, absence of bladder/small bladder, positive contrast cystourethrography w leakage of contrast material out of bladder)
how do you treat traumatic rupture of bladder –> uroabdomen?
- stabilize! treat other life threatening injuries, metabolic abnormalities (K+ for example)
- unless patient has urosepsis, uroabdomen is only a MEDICAL emergency, not a surgical one
- surgery is last resort
- divert urine away
- mucosa sealed in 5-7 days, back to function in 3 weeks
how can urinary bladder herniation happen? how do you treat?
trauma, pre-existing disease (perineal hernias), iatrogenic (poor body wall closure). prepubic tendon rupture (from trauma, etc) (rad shows prepubic tendon rupture resulting in abdominal hernia)
medical stabilization, reposition bladder, repair of defect in body wall
what are the 3 urachal anomaly types?
- urachal diverticulum
- patent urachus
- urachal cyst
why is persistent urachus a problem?
ventral ligament of bladder made of remnants of urachal vein and umbilical vein
if entirety remains patent, leakage of urine out of umbilicus
Urinary bladder neoplasia is usually _____ (benign/malignant). what is the most common urinary bladder neoplasia?
malignant
transitional cell carcinoma
how do you treat transitional cell carcinoma? why does location of the tumor matter?
dog TCC is usually at trigone of bladder, and you need that, so can’t resect –> medical mgmt
cat TCC is usually at apex, so lots of room to resect
basically, if it’s at trigone, it’s a medical case. if its not at trigone, it can potentially be resected.
urethral tears are usually caused by _____.
iatrogenic (unblocking)
how are urethral tears diagnosed?
retrograde contrast urethrogram
this is the penis from a 1yo MI pug. what is it and how do you treat it?
urethral prolapse (red-purple mass protruding from tip of penis). common in male intact young dogs, esp brachys
tx concomitant infection, urolithiasis, anatomical abnormalities first. neuter that bitch and address brachy airway problems (bc sexual excitement and dyspnea may be predisposing factors)
surgically, can reduce or resect/anastamose
what are the C/S of urethral neoplasia? what is important to know if you see these signs?
hematuria, stranguria, dysuria, polyuria. mainly older female dogs
biopsy
how do you treat urethral cancer?
medical
you have a dog with uroliths that you just unblocked. the stones are in the bladder now and you suggest surgery to get them out. the owner asks you “why can’t we just leave those stones in there?”. What do you tell them?
the stones can be a nidus of infection, can potentially obstruct urine inflow/outflow, or go back into urethra/etc. Now, your dog is likely to get uroliths again, and the buildup could make things worse too.
which urolithes are radiopaque? which stones are radioluscent?
opaque: calcium oxalate, struvite
luscent: urates, cysteine
how do you diagnose uroliths?
- rads
- US if radiolucent
- CT
- contrast cystourethrogram if radiolucent in male dog
how do you treat uroliths?
relieve obstruction!!!! retro-hydropulsion!!!!
treat post renal azotemia/other metabolic abnormalities first if present
surgical removal of stones (not urgent, can wait a few hours/overnight)
cystotomy bladder incisions should be _____. why?
ventral
avascular site, avoids trigone
dorsal area is full of vessels and nerves
how do you close the bladder in a cystotomy?
1 layer, 3-0 or 4-0 PDS, simple continuous
what should you do post-op of a cystotomy to remove bladder stones?
rads to confirm removal
contrast study if radiolucent to start with
give methadone!
when would you do a urethrotomy?
if unable to retropulse stones from urethra into bladder
male dogs, often stones get stuck proximal to os penis
how can you close urethrotomy incisions?
- second intension (but may bleed every time they urinate bc of cavernous tissue or if excited). heals in 7-10 days
- primary with 4-0 to 5-0 absorbable
when would you perform a urethrostomy?
- recurrent FLUTD and obstruction in male cat
- strictures secondary to previous trauma or injury to penile or urethral tissue
- obstructions that cannot be relieved/repaired
- recurrent uroliths and obstruction in male dog (maybe)
- neoplasia of penis and prepuce
REFERRAL!!!!!!
what is the difference between urethrotomy and urethrostomy?
urethrotomy: making an incision into urethra
urethrostomy: making a permanent hole in urethra
what is the difference between dog and cat urethrostomies?
dog: scrotal urethrostomy
cat: urethra incised to level of bulbourethral glands (perineal urethrostomy)
what is important to know about ureteronephrectomy?
- isolate renal artery, rental vein, and ureter
- ligate and transect renal artery first!
- ureter must be dissected to level of insertion on bladder
