Urinary Tract Surgery Flashcards
Kidney and ureter surgery
Nephrectomy
Ectopic ureter
Bladder
Rupture
Urolithiasis
Prolapse
Urethra
Persistent urachus
Urolithiasis
Tears
Chronic Kidney Failure: clinical stmptoms
Fever, lethargy, anorexia, weight loss
In there’s an obstruction:
- Colic, stanguria, hematuria
- Pollaikuria- frequent urination
If unilat- kindey function will be ok
If bilat: azotemia
Diagnosis of chronic kidney failure
Paplation- externally or rectally
US: stones <1cm difficult to find
Endoscopy
Urine/ blood: urea and creatinine
Radio: urography, pyelography, retrograde contrast radiography
Congenital kindey and ureter diseases
Ectopic ureter: very rare!!
Ureter defect e.g ureterorexis is more frequent
Diseases of kidney requiring surgery
UROLITH- mainly
Tumour
- Carcinoma, adenocarcinoma (most frequent) nearly al most metastasis therefore poor prognosis even if unilat!
- Adenoma
- Nephroblastoma
Nephrectomy in foals vs adults
Indications for this surgery are rare!
Foals: laparotomy
Adults: resection of last or second last rib
Anatomy of the bladder
Inside: SM
Outside: circular (SM?)
Dorsal crossing: circ m outside
Arteries become rudimentary ligaments of the bladder
Bladder rupture causing uroperitoneum
FOALS: rupture during delivery when the bladder of the foal was full- usually on dors aspect
May also be due to: megavesica
Congenital anomalies: where urethral valves block the urethra but this is rare
Clinical signs/diagnosis of bladder rupture
LEthargy
Enlarged abdomen
Mild colic
Arrhythmia! because of incr K
Urination???
LAbour
Decr Na and Cl
Increased K
Azotemia
High creatinine in the serum/peritoneal fluid
Treatment of bladder rupture: primarily treating the hyperkalaemia
23% Ca borogluconate
Nacl 09%
Dextrose
Surgically drain the urine from the abdomen
Foley catheter 3-5 days
Broad spec AB’s
NO LRS!! or infusions containing lactate
How should you operate if entire length of the bladder is ruptires
Resection of very thin wound edges
Suburethral continuous suture
Some interrupted sutures as a second layer- allows bladder to enlarge
US of the umbilicus- what are the structures to find
2x umbilical arteries
1x umbilical vein
Maybe the urachus
What to check:
if its ok from outside
Fluid in the abd
Gas in the umbilical area
Swelling
Uroliths
In males over females beacuse females urethra is horter- will pass them easier
CALCUM CARBONATE
Type I: yellow, easy to break up, adhered to the wall
Type II: smooth and difficult to break up, contains phosphate
Sedment: is secondary and usually occurs in older horses (may occur in kidney pelvis also)
Clinical signs of uroliths
Hematuria
Stranguria
Colic
Pollakisuria
Small bladder- in the pelvic cavity
If bladder large indicates sediment
Surgical treatment of uroliths
Urethrotomy- someone in rectum holds the bladder, perform urethrotimy above ischial arch with a hammer and stick- destroy stones and remove peices through the wound
Cystotomy: under GA, bladder is in the pelvis- try and expand with catheter and physio saline through the linea alba wound (paramediam incision)
Lithiotrypsy: laser, shock wave
Postop care of urolith surgery
Maintain pH of 8-9 (note the decr of urine pH does not work for horses)
Avoid high Ca intake- triticalia
Give salt- because this increases water intake
Bladder prolapse
Post-partum mares!
Comes out through the vag wound- replace it and then suture the wound
Eversion through urethra- enlarge the entrance of urethra into vagina- cut the neck of it and push the prolapsed part back– there will be discolouration
Urethra
Persistent urachus
- Foals passing urine through the umbilicus- several days/weeks post partum
- Low IgG- from foal not sucking colustrum must control IgG to prevent asc infection or septicaemia
- Broad spec AB’s
Patent urachus
- Foals again, urination through the urethra
- Chemical cauterisation- may lead to adhesions: 7% lugol, silver nitrate and phenol
- Surgical resection if omphalophlebitis is already present
Urethral tear
In geldings/ stallions
Diagnose via urethroscopy- go vertical and then turn horizontal through ischial arch- see bulla like enlargement of urethra- dors on this is frequent location
Hematuria at end of urination
Hemaspermia– infertility
Treatment: urethrotomy
