Urinary Tract Surgery Flashcards
What are the surgical diseases of the kidney?
Nephrolithiasis Pyelonephritis Trauma Neoplasia Hydronephrosis Pseudocysts Renal parasites
What are the surgical procedures of the kidney?
Nephrotomy Partial Nephrectomy Nephroureterectomy Pyelolithotomy Nephrostomy tube Biopsy
4% of all urinary tract calculi are _____
nephroliths
41% of nephroliths are _______
Ca oxalate
Can Ca oxalate crystals be medically managed?
Nope
Clinical signs of nephrolithiasis include…
Can be absent or non-specific CS's Depression Anorexia Hematuria Pain
You should check renal function before performing surgery for nephroliths via…
Excretory urography
GFR
Ultrasound
Surgery for nephrolithiasis is indicated if…
obstruction
infection associated with the calculi
In a patient with asymptomatic nephrolithiasis, you should consider…
monitoring renal function/renal imaging
medical management considerations
surgery damages the kidney
lithotripsy
What surgical approach do you use for a nephrolithotomy?
ventral midline celiotomy
When performing a nephrolithotomy, you should also…
culture the renal pelvis
flush the renal pelvis and ureter
catheterize the ureter to ensure potency
perform a nephropexy
Nephrolithotomy closure options include…
sutures closure - hold for 5 minutes to form a fibrin seal; suture the capsule only
horizontal mattress
What is the maximum vascular clamp time?
20 minutes - OLD EXAM QUESTION
When is a pyelolithotomy used?
to remove calculi when proximal utter and renal pelvis are dilated
Does a pyelolithotomy require vascular occlusion?
Nope
Does a pyelolithotomy damage the nephrons?
Nope
Why should you provide post-pyelolithotomy diuresis?
helps maintain renal perfusion
helps minimize clot formation
In a patient with minor kidney trauma, treatment options include…
surgical repair via hemostatic agents and omental patching
In a patient with major kidney trauma, treatment options include…
partial nephrectomy
nephroureterectomy
Indications for nephroureterectomy are…
severe infection
severe trauma
obstructive calculi with persistent hydronephrosis
neoplasia
transplant
Define hydronephrosis.
Hydronephrosis - progressive dilatation of the renal pelvis and atrophy of the renal parenchyma
*requires immediate treatment
Clinical signs of unilateral hydronephrosis include…
abdominal distension
palpable mass
Clinical signs of bilateral hydronephrosis include..
severe azotemia
death
What diagnostic modalities do you use when you suspect hydronephrosis?
abdominal rads.
ultrasound
excretory urogram
When is a nephroureterectomy indicated in a hydrfonephrotic patient?
chronic cases with non-functional or severe parenchymal damage
What is the remaining function after treating hydronephrosis of <1 week obstruction?
complete resolution
What is the remaining function after treating hydronephrosis of >4 week obstruction?
MAY regain 25% function
What predisposes a patient to pyelonephritis?
damaged parenchyma
How does a patient come down with pyelonephritis?
ascending bacterial infection or hematogenous infection (rare) OR complication of an obstructive uropathy
How do you treat pyelonephritis?
Medical management
The giant kidney worm is called…how do pets get it?
Dioctophyma renale
consuming fish or frog
How does the giant kidney worm affect the kidney?
destroys renal parenchyma
