Urinary Tract Flashcards
1
Q
struvite is more common in males or females?
A
females
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
3
Q
95% of uroliths are…
A
struvite and calcium oxalate
4
Q
calcium oxalate is associ. w/ what urine pH?
A
acidic urine
5
Q
what is the most radio-opaque urolith?
A
calcium oxalate
6
Q
calcium oxalate is more common in males or females?
A
males
7
Q
defective uric acid cycling causes…
A
urate stones
8
Q
which stones are radiolucent?
A
urate and cystine
9
Q
PSS, Liver failure and dalmations are more likely to have what type of stone?
A
urate
10
Q
are silicate stones radiopaque?
A
yes
11
Q
what is the only urolith associated with alkaline urine?
A
struvite
12
Q
what metabolic dz predispose to calcium oxalate stones?
A
Cushing’s (hyperA)
13
Q
which stones look like stars?
A
silicate
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?
15
Q
indications of nephrotomy
A
- nephrolithiasis (if dilated/big)
- haematuria of renal origin
- biopsy needed
16
Q
3 approaches to sx treatment of ureterolith/ureteral obstruction
A
- ureterotomy
- resection/anastomosis
- ureteral reimplantation
17
Q
common complication with ureteral sx
A
ureter so small and fragile often get ongoing leakage post-suturing
18
Q
what is the preferred technique for proximal ureteral obstructions?
A
SUBS
- subcutaneous ureteral bypass system
- is a salvage sx
19
Q
tx of urethral stones
A
- flush ureteral stones back into bladder (retro-hydropulsion)
- stone removal via cystotomy
20
Q
how long should you persist w/ retrohydropulsion of a urethral stone?
A
no longer than 20minutes
21
Q
steps of a cystotomy
A
- Caudal midline coeliotomy - drape in prepuce/vulva
- Pack of urinary bladder w/ moist lap. pads
- Place stay sutures in the apex of the bladder and laterally
- ID the median lig of the bladder and remove this w/ Metzenbaum scissors
- 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
- Remove the stones from the bladder atraumatically (keep stone for analysis)
- 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)
- Flush urethra retrograde
- Flush urethra normograde
rpt flushes + check for stones - Obtain a bladder mucosal sample for C&S
- Close the bladder in simple interrupted appositional closure 4/0 PDS. (submucosa is strength layer)
- Local lavage
- Close body wall
22
Q
What diagnostics should you perform post-op *cystotomy?
A
- stone analysis
- bladder histo/C&S
- rads w/ contrast (for radiolucent stone type)
23
Q
indications for urethrotomy
A
- obstructed males (calculi that cannot be retropulsed)
- strictures
24
Q
2 approaches to urethrotomy in the male
A
perineal or prescrotal
25
what location do you perform a urethrostomy in the male?
scrotal - urethra widest and most superficial
| - less urine scalding
26
indications for urethrostomy
- severe urethral or penile trauma
- recurrent obstruction (medical management failed)
- unresolvable obstruction
- stricture
- neoplasia
- penile amputation
27
complications of canine scrotal urethrostomy
- haemorrhage 3-7d
- stricture ***need magnification to get perfect tissue layer aposition
- dehiscence
- UTI
28
what is FLUTD?
feline idiopathic/interstitial cystitis
- most common cause for urethral obstruction
- sterile urethral plug or inflammation
29
current tx strategy of FLUTD male cats?
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
30
advantages of placing a cystostomy tube in a FLUTD cat?
- 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
31
indications of cystostomy
- FLUTD
- urethral obstruction
- damaged/traumatised urethra
- bladder atony
32
cystostomy technique steps
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
33
ideally a cystostomy tube stays in place for how many days?
14 days minimum to allow fibrous adhesions to abdominal wall
34
indications for a perineal urethrostomy
- challenge and still no urine
- stricture/unresolvable blockage
- recurrent episodes refractory to medical management
35
goal of perineal urethrostomy
enlarge the urethral opening to prevent blockage
36
does PU predispose to a UTI?
no
37
does PU predispose to incontinence?
no
38
what is a PU?
amputation of penis and scrotum --> meticulous suturing of urethra to skin to create a large opening
39
abdominocentesis analysis of a uroabdomen
- elevated creatinine 2.4xserum
- elevated K+ 1.4x serum
- +/- neutrophils, bacteria
40
management of uroabdomen as medical emergency
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
what is acquired urethral sphincter mechanism incompetence associated with?
gonadectomised females, older, large breed
42
prognosis for puppy with urethral sphincter mechanism incompetence
w/ congenital USMI - 50% resolve w/ first oestrus
43
neutered bitches w/ USMI have a problem with smooth or striated muscle in the urethra?
smooth!
44
medical management of USMI focuses on what?
the tone of urethral smooth muscle (internal sphincter)
45
give 2 examples of a-adrenergic agonists used to tx USMI
- phenylpropanolamine
| - pseudoephedrine
46
MOA of a-adrenergic agonists in USMI
that contract the urethra acting on a- receptors
47
response rate of a-adrenergic agonists to tx USMI
80%
48
complications ot a-adrenergic agonists tx of USMI
- hypertension
- restlessness
- anxiety
- tachycardia
49
how does diethylstilboestrol tx USMI?
it improves the smooth muscle sensitivity to a-adrenergic stimulation
50
response to diethylstilboestrol tx of USMI
65%
51
complications of diethylstilboestrol tx of USMI
- vulval swelling + attraction to male dogs
| - higher doses assoc. w/ bone marrow suppression
52
success rate of colposuspension to tx USMI
~50%
53
what does a colposuspension achieve?
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
risk of colposuspension
can compress the urethra
55
success rate of colposuspension + urethropexy to tx USMI
~70%
56
what is a urethropexy?
urethra pexied to prepubic tendon
57
success rate of urethropexy to tx USMI
55%
58
new surgical txs of USMI focus on what?
the tone of the urethral smooth muscle (internal sphincter)
59
which surgical techniques focus on the physical properties of the urethra to tx USMI?
colposuspension + urethropexy
60
what agents are used for urethral submucosal injections
teflon/collagen
61
benefits of artificial hydraulic sphincter tx of USMI
- high success: 91% achieved complete continence
- if medical management fails - good option
- O cannot commit to daily meds $$/time constraints
62
where should the ureter enter the bladder?
into the trigone
63
ectopic ureters are usually intramural in dogs or cats?
| and extramural in dogs or cats?
intramural dogs
| extramural cats
64
other abnormalities associated with ectopic ureters
- USMI
- hypoplastic bladder
- Secondary hydronephrosis/hyroureter/pyelonephritis
65
signalment assoc. w/ ectopic ureters
- female
| - labs, goldens, huskies, WHWT, poodles, newfies, bulldogs
66
common findings assoc. w/ ectopic ureters
- perivulvar staining
- UA: concurrent UTI, crystalluria
- incontinent since puppy - positional/nocturia
67
what imaging modality is necessary to determine surgical approach to ectopic ureters?
contrast CT
68
4 options to tx ectopic ureters
1. Neoureterostomy - new opening
2. Ureteroneocystostomy - ureteral re-implantation
3. Laser-guided ablation (for intramural only)
4. Nephroureterectomy - remove kidney and ureter
69
prognosis after sx treatment of ectopic ureters
1. Often not a cure: 22-67% full restoration of continence
| 2. Ongoing medications: further 7-28% improvement
70
common causes of a urethral prolapse
Young, intact bulldogs and yorkies
+ Excitement
+ UTI
71
surgical approach to urethral prolapse
- resection of redundant mucosa + anastomosis to penile mucosa
- urethropexy
+ castrate --> sexual excitement causing over-protrusion
72
common canine renal neoplasias
- carcinoma, sarcomas, nephroblastomas
73
nodular dermatofibrosis is associated with what dog breed?
GSD
74
most common renal neoplasia of cats
lymphoma
75
technique of renal biopsy
tangential to surface to sample cortex only!
76
indications for nephroureterectomy
- severe hydronephrosis or pyelonephritis
- haemorrhage
- neoplasia
- cysts
CHECK FUNCTION OF CONTRALAT KIDNEY!
77
3 types of malignant bladder neoplasias
TCC (most common)
SCC
Leiomyosarcoma
78
benign bladder neoplasias?
leiomyoma, fibroma
| polyp
79
Ddx. for urolithiasis
bladder neoplasia causing a partial or complete obstruction
80
what condition to sx tx bladder neoplasia by partial cystectomy
trigone is unaffected and neoplasia benign
81
what drugs can be used to medically tx bladder neoplasia?
piroxicam + cyclophosphamide
