Urinary Tract Surgery

Question 1

What are the surgical diseases of the kidney?

Answer 1

Nephrolithiasis
Pyelonephritis
Trauma
Neoplasia
Hydronephrosis
Pseudocysts
Renal parasites

Question 2

What are the surgical procedures of the kidney?

Answer 2

Nephrotomy
Partial Nephrectomy
Nephroureterectomy
Pyelolithotomy
Nephrostomy tube
Biopsy

Question 3

4% of all urinary tract calculi are _____

Answer 3

nephroliths

Question 4

41% of nephroliths are _______

Answer 4

Ca oxalate

Question 5

Can Ca oxalate crystals be medically managed?

Answer 5

Nope

Question 6

Clinical signs of nephrolithiasis include…

Answer 6

Can be absent or non-specific CS's
Depression
Anorexia
Hematuria
Pain

Question 7

You should check renal function before performing surgery for nephroliths via…

Answer 7

Excretory urography
GFR
Ultrasound

Question 8

Surgery for nephrolithiasis is indicated if…

Answer 8

obstruction

infection associated with the calculi

Question 9

In a patient with asymptomatic nephrolithiasis, you should consider…

Answer 9

monitoring renal function/renal imaging
medical management considerations
surgery damages the kidney
lithotripsy

Question 10

What surgical approach do you use for a nephrolithotomy?

Answer 10

ventral midline celiotomy

Question 11

When performing a nephrolithotomy, you should also…

Answer 11

culture the renal pelvis
flush the renal pelvis and ureter
catheterize the ureter to ensure potency
perform a nephropexy

Question 12

Nephrolithotomy closure options include…

Answer 12

sutures closure - hold for 5 minutes to form a fibrin seal; suture the capsule only
horizontal mattress

Question 13

What is the maximum vascular clamp time?

Answer 13

20 minutes - OLD EXAM QUESTION

Question 14

When is a pyelolithotomy used?

Answer 14

to remove calculi when proximal utter and renal pelvis are dilated

Question 15

Does a pyelolithotomy require vascular occlusion?

Answer 15

Nope

Question 16

Does a pyelolithotomy damage the nephrons?

Answer 16

Nope

Question 17

Why should you provide post-pyelolithotomy diuresis?

Answer 17

helps maintain renal perfusion

helps minimize clot formation

Question 18

In a patient with minor kidney trauma, treatment options include…

Answer 18

surgical repair via hemostatic agents and omental patching

Question 19

In a patient with major kidney trauma, treatment options include…

Answer 19

partial nephrectomy

nephroureterectomy

Question 20

Indications for nephroureterectomy are…

Answer 20

severe infection
severe trauma
obstructive calculi with persistent hydronephrosis

Question 21

neoplasia

Answer 21

transplant

Question 22

Define hydronephrosis.

Answer 22

Hydronephrosis - progressive dilatation of the renal pelvis and atrophy of the renal parenchyma
*requires immediate treatment

Question 23

Clinical signs of unilateral hydronephrosis include…

Answer 23

abdominal distension

palpable mass

Question 24

Clinical signs of bilateral hydronephrosis include..

Answer 24

severe azotemia

death

Question 25

What diagnostic modalities do you use when you suspect hydronephrosis?

Answer 25

abdominal rads.
ultrasound
excretory urogram

Question 26

When is a nephroureterectomy indicated in a hydrfonephrotic patient?

Answer 26

chronic cases with non-functional or severe parenchymal damage

Question 27

What is the remaining function after treating hydronephrosis of <1 week obstruction?

Answer 27

complete resolution

Question 28

What is the remaining function after treating hydronephrosis of >4 week obstruction?

Answer 28

MAY regain 25% function

Question 29

What predisposes a patient to pyelonephritis?

Answer 29

damaged parenchyma

Question 30

How does a patient come down with pyelonephritis?

Answer 30

ascending bacterial infection or hematogenous infection (rare) OR complication of an obstructive uropathy

Question 31

How do you treat pyelonephritis?

Answer 31

Medical management

Question 32

The giant kidney worm is called…how do pets get it?

Answer 32

Dioctophyma renale

consuming fish or frog

Question 33

How does the giant kidney worm affect the kidney?

Answer 33

destroys renal parenchyma