Urinary Tract Surgery

Question 1

Kidney and ureter surgery

Answer 1

Nephrectomy

Ectopic ureter

Question 2

Bladder

Answer 2

Rupture

Urolithiasis

Prolapse

Question 3

Urethra

Answer 3

Persistent urachus

Urolithiasis

Tears

Question 4

Chronic Kidney Failure: clinical stmptoms

Answer 4

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

Question 5

Diagnosis of chronic kidney failure

Answer 5

Paplation- externally or rectally

US: stones <1cm difficult to find

Endoscopy

Urine/ blood: urea and creatinine

Radio: urography, pyelography, retrograde contrast radiography

Question 6

Congenital kindey and ureter diseases

Answer 6

Ectopic ureter: very rare!!

Ureter defect e.g ureterorexis is more frequent

Question 7

Diseases of kidney requiring surgery

Answer 7

UROLITH- mainly

Tumour

• Carcinoma, adenocarcinoma (most frequent) nearly al most metastasis therefore poor prognosis even if unilat!
• Adenoma
• Nephroblastoma

Question 8

Nephrectomy in foals vs adults

Answer 8

Indications for this surgery are rare!

Foals: laparotomy

Adults: resection of last or second last rib

Question 9

Anatomy of the bladder

Answer 9

Inside: SM

Outside: circular (SM?)

Dorsal crossing: circ m outside

Arteries become rudimentary ligaments of the bladder

Question 10

Bladder rupture causing uroperitoneum

Answer 10

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

Question 11

Clinical signs/diagnosis of bladder rupture

Answer 11

LEthargy

Enlarged abdomen

Mild colic

Arrhythmia! because of incr K

Urination???

Question 12

LAbour

Answer 12

Decr Na and Cl

Increased K

Azotemia

High creatinine in the serum/peritoneal fluid

Question 13

Treatment of bladder rupture: primarily treating the hyperkalaemia

Answer 13

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

Question 14

How should you operate if entire length of the bladder is ruptires

Answer 14

Resection of very thin wound edges

Suburethral continuous suture

Some interrupted sutures as a second layer- allows bladder to enlarge

Question 15

US of the umbilicus- what are the structures to find

Answer 15

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

Question 16

Uroliths

Answer 16

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)

Question 17

Clinical signs of uroliths

Answer 17

Hematuria

Stranguria

Colic

Pollakisuria

Small bladder- in the pelvic cavity

If bladder large indicates sediment

Question 18

Surgical treatment of uroliths

Answer 18

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

Question 19

Postop care of urolith surgery

Answer 19

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

Question 20

Bladder prolapse

Answer 20

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

Question 21

Urethra

Answer 21

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

Question 22

Urethral tear

Answer 22

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