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Surgery final > Urinary tract surgery SA (Case) > Flashcards

Urinary tract surgery SA (Case) Flashcards

1
Q

Lecture goals

A
  1. Undersetand basic pathophysiology
    • calculi and FUS
  2. Know indications for bladder and urethral surgery
  3. Know suture materials and patterns for bladder and urethral sx
  4. Know principles of bladder and urethral sx
  5. Know common complications of bladder and urethral surgery
  6. Know of various sx procedures
    • nephrectomy
    • nephrotomy
    • ureterotomy
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2
Q

To visualize right gutter

A
  • retract mesoduodenum to visualize
    • R. Kidney
    • vena cava
    • ureter
    • bladder
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3
Q

To visualize trigone of bladder

A
  • extend incision caudally enough and retroflex bladder
    • UVJs (ureteral vesicular junctions)
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4
Q

To visualize left gutter

A
  • retract spleen and descending colon medially and caudally
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5
Q

Bladder suture and patterns

A
  • 4-0 to 7-0
    • bladder, urethra, ureter
  • absorbable
    • bladder, urethra, ureter
  • monofilament
    • bladder, urethra, ureter
  • avoid luminal sutures
    • bladder
  • simple continuous/simple interrupted are ok

*PDS full thickness closure would be a bad idea! :-D

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6
Q

Nephrotomy

A
  • rare
  • renoliths/nephroliths
    • rarely a problem
  • avoid
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7
Q

Nephrectomy

A
  • rare
  • indications
    • trauma
    • neoplasia
    • abscess
  • structures
    • vessels: double ligate artery and transfixing ligament as 2nd ligature
    • ureter: remove completely

*Kidneys can usually be saved

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8
Q

Ureterotomy

A
  • not done as commonly as previously
    • stint and special devices now
  • high complication rate
    • 20% mortality rate for cats
  • magnification
  • suture: 5-0 to 7-0
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9
Q

Cystotomy

A
  • very common
  • indications
    • calculi
    • rupture
    • mass/polyp
    • access to ureter/urethra
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10
Q

dog-epidemiology

stones

A
  • Sex predisposition
    • females - calculi
    • males - obstruction
  • Breed
    • dalmations
  • vascular malformations
    • PSS
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11
Q

Dog

type of stones

A
  • calculi
    • struvite
    • oxalate
    • urate
    • cysteine
  • submit your stones (medically mandated)
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12
Q

Calculi epi dogs

sex predisposition

A
  • Females
    • calculi
    • anatomy = inc incidence of UTI
      • struvite formation secondary to urease bacteria
  • Males
    • most commly obstructed
    • Anatomy
      • urethral diameter
      • lenth
      • os penis
    • Ca-oxalate, urate, cystine
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13
Q

Calculi epi dogs

Breed

A
  • dalmations
    • uricase transport defect
    • urate
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14
Q

Calculi epi dogs

vascular malformations

A
  • Portosystemic shunt
    • ammonia excretion
    • urate
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15
Q

Two most common urinary stones

A
  • Calcium Oxalates
  • Struvite
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16
Q

most common stone in female dogs

A
  • struvites
    • short-wide urethra next to source of contaminates = bacterial infection
      • staph, clebsiella, …
17
Q

Feline Urologic Syndrome (FUS)

A
  • sterile, inflammatory cystitis
  • multifactorial
    • dietary, obesity, stress, neuroendocrine, viral?
  • Neg bact culture (97%)
  • 45% recur in 6 months
18
Q

Cat epi

Sex

A
  • Females
    • sterile cystitis
    • non-obstructive
    • hematuria, pollakiuria (extreme urinary frequency)
  • Males
    • urethral plugs
      • mucus, blood, crystals
        • struvites (90%)
        • oxalates (1%)
    • recur in weeks to months (50% of cases)
19
Q

Preoperative treatment

Dog

A
  • Retrograde urohydropulsion
    • goal: flush urethral calculi back into bladder
    • allows stabilization before sx
    • avoids emergency urethral sx
      • elective cystotomy preferred to urethrotomy/urethrostomy
20
Q

Preoperative tx

cat

A
  • sedation
    • lidocaine jelly
    • BAR or angry/growling
      • low dose injectibles
        • butorphanol
        • diazepam
        • ketamine: not too much, metabolized by kidneys
21
Q

Preop tx

Cat: catheter tips

A
  • catheter tips
    • dorsal recumbency
    • legs cranial
    • extend penis caudal
22
Q

Suture selection

A
  • absorbable monofilament
23
Q

Cystotomy suture

A
  • monocryl or biosyn
    • biosyn if nasty infection (monocryl breaks down VERY quick)
  • NO PDS, NO MAXON
    • ​suture nidus risk
24
Q

Urethrostomy suture

A
  • monocryl or biosyn
25
Q

cycstotomy procedure

A
  • dorsl recumbancy, wide clip
    • caudal midline laparotomy (umbilicus to in front of prebubic tendon)
  • Access to urethral catheter
  • Isolate with lap sponges
  • retract with large guelpis
  • 3 stay sutures (hemostats if no assistant)
    • cranial one most important
  • 15 blade ventral midline stab
    • evacuate urine with suction (Poole)
    • protect viscera from urine
    • extend incision to visualize all of bladder
  • Spoon out stones
  • Flush normograde and retrograde
    • drape in prepuce
26
Q

Cystotomy closure

A
  • single layer continuous/interrupted
  • double layer cont/int
    • decreases luminal volume
    • serosal tearing
  • leak test following closure
    • retrograde urethral catheter
27
Q

Cystotomy complications

A
  • hematuria and pollakiuria
    • common/expecte for 48 hours
  • dehiscence/uroabdomen
    • rare, related to poor technique
    • bladder gains majority of tensile strength in 5-7 days
      • 100% at 14-21 days
    • snug appositional single-layer closure engaging submucosa
  • incomplete urolith removal
    • stones fall into pelvic urethra
    • copiously flush retrograde
    • must count stones
    • post-op rads: butt-shot
28
Q

cystectomy

A
  • rare
  • indications
    • neoplasia
    • trauma
    • dalmations
  • can excise up to 70%
    • unless near trigone and ureters

*resectable TCC is rare

29
Q

Cystectomy procedure

A
  • use stay sutures for exposure
    • assistant required
  • debride edges
  • suture
    • one layer
    • approximating pattern preferred
30
Q

Urinary diversion

A
  • rare
  • urethral repairs
    • cystostomy tube
    • urethral stent
  • light fentanyl CRI for sick dog sufficient
31
Q

cystopexy

A
  • rare
  • retroflexed bladder in perineal hernia
  • incisional
  • right side peritoneal lining
32
Q

Urethrotomy

A
  • rare
  • remove single calculus
  • leave open/suture closed
  • risk of structure
33
Q

Urethrostomy

A
  • common
  • dogs
    • male
      • prescrotal
      • scrotal
      • perineal
    • female
      • prepubic
34
Q

Scrotal urethrostomy complications

A
  • persistent hemorrhage
    • 2-3 days
  • hematuria
    • up to 5 days
  • dehiscence and stricture
    • rare; trauma and poor technique
  • urine scald and UTI
    • intermittent: 20% of cases
35
Q

Urethrostomy

cats

A
  • perineal: larger dilation of urethra
  • prepubic
36
Q

Perineal urethrostomy cats

complications

A
  • hemorrhage
    • expected first 48 hours
    • don’t disrupt the clot
    • avoid heparin
  • dehiscence
    • urine dissecation
    • inflammation/infection
    • necrosis
    • self-trauma: E-collar always
  • stricture/recurrence
    • improper technique
    • must perform complete dissection broximal to BUGs
37
Q

Summary

A
  • know indications for bladder sx
  • pathophys of stone formation
  • indications for urethral procedures

Surgery final (9 decks)

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