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Small Animal Surgical Diseases > Urinary Tract Surgery > Flashcards

Urinary Tract Surgery Flashcards

1
Q

What are the clinical signs of urinary tract disease?

A
  • straining
  • hematuria
  • odor
  • dysuria or anuria
  • pollakiuria
  • abdominal discomfort
  • lethargy
  • vomiting
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2
Q

A patient presents to your clinic because the owner reports that she has been straining to urinate and not producing a ton of urine. She says that the few drops that do come out are red-tinged. What diagnostics do you want to start with for this patient?

A

Min database (CBC/Chem/UA, urine culture)

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3
Q

The kidneys are located in the __________ space.

A

retroperitoneal

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4
Q

which side of the kidney is the artery, vein, nerve, and ureter running out of?

A

the hilus (the concave side)

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5
Q

what are the 2 natural retractors that you can utilize to better visualize the kidneys?

A

mesocolon to see the left
mesoduodenum to see the right

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6
Q

which kidney is MORE mobile – L or R?

A

left

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7
Q

The renal veins empty into the ____________.

A

caudal vena cava

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8
Q

Which renal artery is longer – L or R?

A

right - its more cranial
the left renal artery may be paired

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9
Q

The renal arteries are between which 2 arteries?

A

cranial and caudal mesenteric arteries

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10
Q

What size should the kidneys be on radiographs?

A

2-3x the length of the adjacent vertebrae

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11
Q

Renal ultrasound gives you information about what?

A

the structure of the kidney and renal blood flow.

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12
Q

Which imaging modality gives you information that reflects kidney function?

A

nuclear scintigraphy

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13
Q

Why is renal biopsy no longer common?

A

concern for damaging the kidney and/or penetrating vessels.

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14
Q

Wedge biopsy, chronic infection or hematuria, renal calculi, or persistent hydronephrosis are all indications to perform what procedure?

A

nephrotomy

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15
Q

For a pyelolothitomy (a surgery preferred over the nephrotomy), where do you make your incision?

A

into the renal pelvis
you must dilate the pelvis and proximal ureter in order to remove the nephroliths.

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16
Q

Why is pyelolothitomy preferred over the nephrotomy?

A

no occlusion of renal blood flow
no damage to renal parenchyma

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16
Q

What are the indications for a nephroectomy?

A
  1. hydronephrosis (from urolithiasis, a stricture, masses, or iatrogenic causes)
  2. renal neoplasia
  3. renal cysts or abscesses
  4. trauma (rupture kidney or avulsion of renal artery)
  5. infection (dioctophyma renale)
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17
Q

What is the following procedure described below?
make a midline celiotomy, retract and visualize the kidney, incise the peritoneum, free the kidney from the sublumbar attachments, reflect the kidney medially to expose the vessels, isolate them, triple ligate them, and cut

A

nephrectomy

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18
Q

T/F: when ligating the renal vessels, you can use thoracoabdominal stapling devices, vicryl, PDS, or silk

A

true

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19
Q

when ligating the renal vessels, which should you ligate first – the artery or the vein?

A

does not matter! whichever one you can get to and ligate the quickest.

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20
Q

what are important elements of post-operative care for patients undergoing nephrectomies?

A

fluids
analgesics
serial BP monitoring

complications include hemorrhage or renal dysfunction/failure (of the other kidney)

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21
Q

T/F: ureteral surgery is manageable by a general practioner

A

mostly false – these surgeries require tiny instruments and magnification. The ureters are sensitive, do not like to be manipulated, are very prone to leakage and strictures, and generally do not like to heal.
Therefore, these surgeries are best done by a specialist or someone who is very well experienced.

22
Q

what are the 2 most common ureteral procedures?

A
  1. neoureterocystotomy
  2. ureterotomy
23
Q

Which area of the bladder is very important to maintain health of due to it being the location of cellular regeneration (repithelialization and healing originates in this area and migrates elsewhere).

A

trigone (its the dorsal portion of the bladder neck that contains the ureteral orifices)

24
Q

what are the ligaments of the bladder?

A
  1. lateral ligaments (2) – connect the bladder to the walls of the pelvic canal; these ligaments enclose the ureters and umbilical arteries.
  2. ventral ligament – connects the bladder to the pelvic symphysis and linea alba.
25
Q

what 2 arteries provide blood supply to the bladder?

A
  1. cranial vesicular artery (which is only present in 50% of adult dogs)
  2. caudal vesicular artery
26
Q

what veins drain the bladder?

A

internal pudendal veins

27
Q

where does lymphatic drainage of the bladder go?

A
  • sublumbar LN
  • hypogastric LN
  • medial iliac LN
28
Q

what is the smooth muscle of the bladder responsible for bladder contraction?

A

detrusor muscle

29
Q

_________ nerve is sympathetic innervation to the bladder that allows for detrusor muscle relaxation and urethral smooth muscle contraction to aid in urine retention.

A

hypogastric nerve

30
Q

_________ nerve is parasympathetic innervation to the bladder that allows for detrusor muscle contraction and bladder emptying.

A

pelvic nerve

31
Q

________ nerve is somatic innervation to external urethral sphincter allowing for urine retention and voluntary control of micturition.

A

pudendal nerve

32
Q

what are 3 radiographic diagnostic options for bladder issues?

A
  1. contrast cystogram
  2. pneumocystogram
  3. double contrast cystogram
33
Q

You are performing an ultrasound on a patient with urinary symptoms. You see something bright within the bladder that is casting a shadow. What is this most likely?

A

stone

34
Q

You are performing an ultrasound on a patient with urinary symptoms. You see something with soft tissue opacity that is intraluminal in the bladder. What is this most likely?

A

tumor

35
Q

what are the indications for a cystotomy?

A
  1. to remove calculi
  2. explore the UB for biopsy +/- culture
  3. neoplasia
  4. repair of ectopic ureters
  5. trauma
36
Q

what portion of the bladder do you incise for a cystotomy?

A

apex
and you should incise JUST big enough for the biggest stone to fit through.

37
Q

What is arguably the most important part of the cystotomy procedure?

A

catheterizing the urethra and lavaging thoroughly to ensure you remove all stones even the tiny little bits.
Retrograde hydropulsion is preferred.

38
Q

what is the holding layer of a cystotomy closure?

A

submucosa

39
Q

what type of suture should you use in your cystotomy closure? (general)

A

absorbable

40
Q

Why should you avoid penetrating the mucosa during your cystotomy closure?

A

weakens your suture
nidus for calculi or infection

41
Q

T/F: the bladder takes at least 45 days to heal

A

false – it heals 100% in 14-21 days. The mucosa re-epithelializes in 30 days.

42
Q

What must you do when you complete your cystotomy?

A

POST-OP XRAYS! to ensure you do not have any residual stones.

then… give your pt analgesics, send calculi off for culture/stone analysis, provide dietary management recommendations, and treat for a UTI.

43
Q

Laparoscopic-assisted cystotomies take longer, are more expensive, and require specialized equipment. Given these downsides, why do some doctors opt to do these instead of normal cystotomies?

A

smaller incisions
improve visualization of the calculi in the bladder
less post-op pain

44
Q

What are the 3 potential complications of a cystotomy for removal or urinary calculi?

A
  • uroabdomen
  • recurrence of stones
  • infection
45
Q

How do you diagnose urinary bladder rupture?

A

contrast radiography

46
Q

T/F: if you have bladder trauma, you can safely remove up to 75% of the bladder (cystectomy), avoiding the trigone, and still have a good prognosis.

A

true

47
Q

why do we pack off the abdomen when doing a partial cystectomy for neoplastic concerns?

A

to avoid tumor seeding!

you also need to change your instruments and gloves after handling any neoplastic lesions.

48
Q

how much bladder should you remove if you have concerns for neoplasia?

A

1 cm of bladder around the tumor

49
Q

what is the prognosis for bladder neoplasia treated with partial cystectomy?

A

guarded.

50
Q

Below are indications for what procedure?
- persistent urethral obstruction
- recurrent urethral obstruction
- urethral structure
- penile neoplasia
- penile trauma
- salvage procedure

A

urethrostomy

51
Q

what are the 4 potential locations for urethrostomy?

A
  1. prescrotal
  2. scrotal (dogs)
  3. perineal (cats)
  4. prepubic or antepubic
52
Q

what are the complications for scrotal urethrostomy?

A

hemorrhage
dermatitis / urine scald
dehiscence
stricture
UTI

53
Q

what important considerations should be taken in post-operative care for cats that have just undergone a perineal urethrostomy?

A
  1. place e-collar
  2. use shredded paper NOT litter
  3. do not disturb any clots
  4. no urinary catheter placement

Small Animal Surgical Diseases (20 decks)

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