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Surgery > Urinary Tract > Flashcards

Urinary Tract Flashcards

1
Q

struvite is more common in males or females?

A

females

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2
Q

struvite is associated with what bacteria and pH?

A

urease producing bacteria (urea –> ammonia –> ammonium + OH)
resulting in an alkaline pH –> precipitation of struvite

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3
Q

95% of uroliths are…

A

struvite and calcium oxalate

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4
Q

calcium oxalate is associ. w/ what urine pH?

A

acidic urine

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5
Q

what is the most radio-opaque urolith?

A

calcium oxalate

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6
Q

calcium oxalate is more common in males or females?

A

males

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7
Q

defective uric acid cycling causes…

A

urate stones

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8
Q

which stones are radiolucent?

A

urate and cystine

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9
Q

PSS, Liver failure and dalmations are more likely to have what type of stone?

A

urate

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10
Q

are silicate stones radiopaque?

A

yes

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11
Q

what is the only urolith associated with alkaline urine?

A

struvite

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12
Q

what metabolic dz predispose to calcium oxalate stones?

A

Cushing’s (hyperA)

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13
Q

which stones look like stars?

A

silicate

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14
Q

when is medical dissolution of stones possible?

A

If struvite, urate or cystine stones of a small size.

*Note- if do not have stone for stone analysis - how do you know stone type?

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15
Q

indications of nephrotomy

A
  • nephrolithiasis (if dilated/big)
  • haematuria of renal origin
  • biopsy needed
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16
Q

3 approaches to sx treatment of ureterolith/ureteral obstruction

A
  • ureterotomy
  • resection/anastomosis
  • ureteral reimplantation
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17
Q

common complication with ureteral sx

A

ureter so small and fragile often get ongoing leakage post-suturing

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18
Q

what is the preferred technique for proximal ureteral obstructions?

A

SUBS

  • subcutaneous ureteral bypass system
  • is a salvage sx
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19
Q

tx of urethral stones

A
  • flush ureteral stones back into bladder (retro-hydropulsion)
  • stone removal via cystotomy
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20
Q

how long should you persist w/ retrohydropulsion of a urethral stone?

A

no longer than 20minutes

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21
Q

steps of a cystotomy

A
  1. Caudal midline coeliotomy - drape in prepuce/vulva
  2. Pack of urinary bladder w/ moist lap. pads
  3. Place stay sutures in the apex of the bladder and laterally
  4. ID the median lig of the bladder and remove this w/ Metzenbaum scissors
  5. Make a stab incision (11 blade) into the ventral surface of the bladder at the level of the median ligament and extend the incision w/ Metzenbaum scissors
  6. Remove the stones from the bladder atraumatically (keep stone for analysis)
  7. Pass a u-cath from the outside (penis) to the level of the obstruction (for a female pass from inside bladder first to help w/ catheterisation)
  8. Flush urethra retrograde
  9. Flush urethra normograde
    rpt flushes + check for stones
  10. Obtain a bladder mucosal sample for C&S
  11. Close the bladder in simple interrupted appositional closure 4/0 PDS. (submucosa is strength layer)
  12. Local lavage
  13. Close body wall
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22
Q

What diagnostics should you perform post-op *cystotomy?

A
  • stone analysis
  • bladder histo/C&S
  • rads w/ contrast (for radiolucent stone type)
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23
Q

indications for urethrotomy

A
  • obstructed males (calculi that cannot be retropulsed)

- strictures

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24
Q

2 approaches to urethrotomy in the male

A

perineal or prescrotal

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25
Q

what location do you perform a urethrostomy in the male?

A

scrotal - urethra widest and most superficial

- less urine scalding

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26
Q

indications for urethrostomy

A
  • severe urethral or penile trauma
  • recurrent obstruction (medical management failed)
  • unresolvable obstruction
  • stricture
  • neoplasia
  • penile amputation
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27
Q

complications of canine scrotal urethrostomy

A
  • haemorrhage 3-7d
  • stricture ***need magnification to get perfect tissue layer aposition
  • dehiscence
  • UTI
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28
Q

what is FLUTD?

A

feline idiopathic/interstitial cystitis

  • most common cause for urethral obstruction
  • sterile urethral plug or inflammation
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29
Q

current tx strategy of FLUTD male cats?

A
  1. IVFT + manage azotaemia
  2. GA –> Pass U-cath to unblock **can be V. difficult
  3. Place cystostomy tube to bypass urethra
  4. Block off tube after a few days to see if cat can urinate
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30
Q

advantages of placing a cystostomy tube in a FLUTD cat?

A
  • you don’t need to leave a U-cath in which causes ongoing inflam
  • bladder remains empty to treat detrusor atony
  • bypass urethra completely (rests to reduce inflam)
  • can occlude to ‘challenge’ bladder intermittently and see if urination through urethra possible
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31
Q

indications of cystostomy

A
  • FLUTD
  • urethral obstruction
  • damaged/traumatised urethra
  • bladder atony
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32
Q

cystostomy technique steps

A
  1. Bladder distended
  2. Small midline skin incision - retraction
  3. Small midline body wall incision (grid incision) - retraction (Gelpis)
  4. Visualise bladder surface
  5. 2-4 sutures through body wall and into bladder (stay sutures)
  6. Cruciform stab (+)
  7. Tube fed through - Foley (w/ guide wire)
  8. Close rectus fascia/sc/skin around tube
  9. Finger trap
  10. Closed collection system
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33
Q

ideally a cystostomy tube stays in place for how many days?

A

14 days minimum to allow fibrous adhesions to abdominal wall

34
Q

indications for a perineal urethrostomy

A
  • challenge and still no urine
  • stricture/unresolvable blockage
  • recurrent episodes refractory to medical management
35
Q

goal of perineal urethrostomy

A

enlarge the urethral opening to prevent blockage

36
Q

does PU predispose to a UTI?

A

no

37
Q

does PU predispose to incontinence?

A

no

38
Q

what is a PU?

A

amputation of penis and scrotum –> meticulous suturing of urethra to skin to create a large opening

39
Q

abdominocentesis analysis of a uroabdomen

A
  • elevated creatinine 2.4xserum
  • elevated K+ 1.4x serum
  • +/- neutrophils, bacteria
40
Q

management of uroabdomen as medical emergency

A
  1. Delay surgery until stable
  2. Reduce K+: insulin + dextrose, terbutaline, IVFT
  3. Reduce cardiotoxicity: calcium gluconate
  4. Peritoneal dialysis/peritoneal catheter (Jackson Pratt Drain) to remove urine
  5. ABs
41
Q

what is acquired urethral sphincter mechanism incompetence associated with?

A

gonadectomised females, older, large breed

42
Q

prognosis for puppy with urethral sphincter mechanism incompetence

A

w/ congenital USMI - 50% resolve w/ first oestrus

43
Q

neutered bitches w/ USMI have a problem with smooth or striated muscle in the urethra?

A

smooth!

44
Q

medical management of USMI focuses on what?

A

the tone of urethral smooth muscle (internal sphincter)

45
Q

give 2 examples of a-adrenergic agonists used to tx USMI

A
  • phenylpropanolamine

- pseudoephedrine

46
Q

MOA of a-adrenergic agonists in USMI

A

that contract the urethra acting on a- receptors

47
Q

response rate of a-adrenergic agonists to tx USMI

A

80%

48
Q

complications ot a-adrenergic agonists tx of USMI

A
  • hypertension
  • restlessness
  • anxiety
  • tachycardia
49
Q

how does diethylstilboestrol tx USMI?

A

it improves the smooth muscle sensitivity to a-adrenergic stimulation

50
Q

response to diethylstilboestrol tx of USMI

A

65%

51
Q

complications of diethylstilboestrol tx of USMI

A
  • vulval swelling + attraction to male dogs

- higher doses assoc. w/ bone marrow suppression

52
Q

success rate of colposuspension to tx USMI

A

~50%

53
Q

what does a colposuspension achieve?

A

the vagina is pexied to the prepubic tendon resulting in bringing the bladder cranially which lengthens the urethra reducing the diameter and increasing resistance

54
Q

risk of colposuspension

A

can compress the urethra

55
Q

success rate of colposuspension + urethropexy to tx USMI

A

~70%

56
Q

what is a urethropexy?

A

urethra pexied to prepubic tendon

57
Q

success rate of urethropexy to tx USMI

A

55%

58
Q

new surgical txs of USMI focus on what?

A

the tone of the urethral smooth muscle (internal sphincter)

59
Q

which surgical techniques focus on the physical properties of the urethra to tx USMI?

A

colposuspension + urethropexy

60
Q

what agents are used for urethral submucosal injections

A

teflon/collagen

61
Q

benefits of artificial hydraulic sphincter tx of USMI

A
  • high success: 91% achieved complete continence
  • if medical management fails - good option
  • O cannot commit to daily meds $$/time constraints
62
Q

where should the ureter enter the bladder?

A

into the trigone

63
Q

ectopic ureters are usually intramural in dogs or cats?

and extramural in dogs or cats?

A

intramural dogs

extramural cats

64
Q

other abnormalities associated with ectopic ureters

A
  • USMI
  • hypoplastic bladder
  • Secondary hydronephrosis/hyroureter/pyelonephritis
65
Q

signalment assoc. w/ ectopic ureters

A
  • female

- labs, goldens, huskies, WHWT, poodles, newfies, bulldogs

66
Q

common findings assoc. w/ ectopic ureters

A
  • perivulvar staining
  • UA: concurrent UTI, crystalluria
  • incontinent since puppy - positional/nocturia
67
Q

what imaging modality is necessary to determine surgical approach to ectopic ureters?

A

contrast CT

68
Q

4 options to tx ectopic ureters

A
  1. Neoureterostomy - new opening
  2. Ureteroneocystostomy - ureteral re-implantation
  3. Laser-guided ablation (for intramural only)
  4. Nephroureterectomy - remove kidney and ureter
69
Q

prognosis after sx treatment of ectopic ureters

A
  1. Often not a cure: 22-67% full restoration of continence

2. Ongoing medications: further 7-28% improvement

70
Q

common causes of a urethral prolapse

A

Young, intact bulldogs and yorkies
+ Excitement
+ UTI

71
Q

surgical approach to urethral prolapse

A
  • resection of redundant mucosa + anastomosis to penile mucosa
  • urethropexy

+ castrate –> sexual excitement causing over-protrusion

72
Q

common canine renal neoplasias

A
  • carcinoma, sarcomas, nephroblastomas
73
Q

nodular dermatofibrosis is associated with what dog breed?

A

GSD

74
Q

most common renal neoplasia of cats

A

lymphoma

75
Q

technique of renal biopsy

A

tangential to surface to sample cortex only!

76
Q

indications for nephroureterectomy

A
  • severe hydronephrosis or pyelonephritis
  • haemorrhage
  • neoplasia
  • cysts

CHECK FUNCTION OF CONTRALAT KIDNEY!

77
Q

3 types of malignant bladder neoplasias

A

TCC (most common)
SCC
Leiomyosarcoma

78
Q

benign bladder neoplasias?

A

leiomyoma, fibroma

polyp

79
Q

Ddx. for urolithiasis

A

bladder neoplasia causing a partial or complete obstruction

80
Q

what condition to sx tx bladder neoplasia by partial cystectomy

A

trigone is unaffected and neoplasia benign

81
Q

what drugs can be used to medically tx bladder neoplasia?

A

piroxicam + cyclophosphamide

Surgery (22 decks)

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