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ACVS Phase II 2023 Case Based Only > Urogenital > Flashcards

Urogenital Flashcards

1
Q

Crivellenti, JAVMA, 2018:
Core needle renal biopsies vs laparotomy or laparoscopic biopsies
What factor(s) were associated with the number of glomeruli obtained per needle core specimen?
Specimens obtained by which approach(es) more commonly contained medullary tissue?

A

Crivellenti, JAVMA, 2018:
Factors associated with the number of glomeruli obtained per needle core specimen:
-needle gauge
-patient age
-serum creatinine concentration
-degree of proteinuria

Specimens obtained via laparotomy or laparoscopic approaches more commonly contained medullary tissue compared to ultrasound-guided approaches

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2
Q

McAloney, JAVMA, 2018:
Cytologic examination of renal FNAs
What % of specimens had slides adequate for interpretation?
Sensitivity of cytologic examination for detection of neoplastic vs non-neoplastic conditions?
Specificity of cytologic examination for detection of neoplastic vs non-neoplastic conditions?

A

McAloney, JAVMA, 2018:
72% of specimens had slides adequate for interpretation
Sensitivity of cytologic examination: 78% for neoplastic conditions vs 50% for non-neoplastic conditions
Specificity of cytologic examination: 50% for neoplastic conditions vs 77% for non-neoplastic conditions

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3
Q

Petrovsky, JAVMA, 2019:
Endoscopic nephrolithotomy
What was the most common nephrolith type?
Procedure-related complications?
Mortality rate?

A

Petrovsky, JAVMA, 2019:
Most common nephrolith type was calcium oxalate
Procedure-related complications: renal puncture-associated hemorrhage requiring blood transfusion, renal capsule tear, ureteral puncture
Mortality rate: 0%

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4
Q

Deroy, JAVMA, 2017:
DPU stents vs SUB devices in cats

Most common peri-op complication of DPU stenting?

Which procedure was more likely to be associated with signs of cystitis?

Peri-op mortality rate for DPU stent vs SUB device placement?

Which procedure was more likely to develop device obstruction due to encrustation in the long-term?

A

Most common peri-op complication of DPU stenting?
-uroabdomen (18%)

Cystitis:
DPU > SUB
52% vs 22%

Peri-op mortality rates:
-18% for DPU
-13% for SUB

Device obstruction due to encrustation in the long-term?
DPU

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5
Q

Pavia, JAVMA, 2018:
Ureteral stenting in dogs
Major and minor intra-op complication rates?
Short-term and long-term complication rates?
What % of dogs developed post-op hematuria?
What % of dogs required stent exchange and what % required stent replacement with a SUB device?
What was associated with requiring stent exchange or replacement?
Pre-op UTI was not associated with the outcome or development of long-term complications - true or false?

A

Pavia, JAVMA, 2018:
Intra-op complication rates: 5% major, 4% minor
Short-term complication rate: 13%
Long-term complication rate: 47%
20% developed post-op hematuria
12% required stent exchange and 4% required stent replacement with a SUB device
Calcium apatite or phosphate stones had an increased risk of requiring stent exchange or replacement
True

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6
Q

Nesser, Vet Surg, 2018:
Ureteral stones in cats
Association between stone size and stone location?

A

Nesser, Vet Surg, 2018:
Larger stone size was associated with a more proximal stone location

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7
Q

Cray, JAVMA, 2018:
Treatment of pyonephrosis with a SUB device
What % of the cats developed post-op occlusion of the cystostomy catheter with purulent material?
What % of cats had resolution of the UTI?

A

Cray, JAVMA, 2018:
25% developed post-op occlusion of the cystostomy catheter with purulent material
75% had resolution of the UTI

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8
Q

Berent, JAVMA, 2018:
SUB device in cats
What % of cats had bilateral ureteral obstruction?
What % of cats were azotemic?
List 3 post-op complications.
Mortality rate?
Most common long-term complication?
What was associated with SUB device occlusion?

A

Berent, JAVMA, 2018:
39% had bilateral ureteral obstruction
95% were azotemic
Post-op complications: device occlusion with blood clots (8%), device tubing kinking (5%), device leakage (4%)
Mortality rate: 6%
Most common long-term complication was catheter mineralization (24% of cases)
High post-op serum ionised calcium concentration was associated with SUB device occlusion

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9
Q

Balsa, JAVMA, 2019:
Post-obstructive diuresis following ureteral stent or SUB device placement in cats
Did cats with anuria before surgery have shorter or longer post-obstructive diuresis?
Mortality rate?
What % of cats had resolution of azotemia?

A

Balsa, JAVMA, 2019:
Cats with anuria before surgery had longer post-obstructive diuresis
Mortality rate: 8%
Azotemia resolved in 50% of the cats

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10
Q

Frem, JAVMA, 2017:
Use of poliglecaprone 25 for PU

What was associated with short term complications?

Was use of post op u-cath associated with complications?

A

Pre-op UTI was associated with the development of minor short-term complications

Use of an indwelling urinary catheter post-op was not associated with post-op complications

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11
Q

Seitz, JAVMA, 2018:
Recurrent Urinary Obstruction after catheter treatment for UO

A

Seitz, JAVMA, 2018:
Recurrent urethral obstruction:
Overall 42%
In patient 11%
Outpatient 13%

In patient recurrence associated with abnormal urine

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12
Q

Hamon, Vet Surg, 2019:
Transobturator vaginal tape inside out
1-year post-op continence rate?
Recurrence rate?

A

Hamon, Vet Surg, 2019:
1-year post-op continence rate: 58%
Recurrence rate: 50% at a median of 2 months post-op

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13
Q

Hamlin, VRU, 2019:
Urinary bladder TCC in cats vs dogs
Location of bladder TCC in cats vs dogs?
Urethral extension of tumor in cats vs dogs?

A

Hamlin, VRU, 2019:
Feline bladder TCC was more likely to be mid-body vs trigonal in dogs
Urethral extension of the tumor was less likely in cats than in dogs

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14
Q

Bennett, Vet Surg, 2018:
Total prostatectomy for prostatic carcinoma in dogs
Distribution of tumor types?
What % of dogs had evidence of nodal metastasis?
Minor and major complication rates?
What % of dogs had permanent post-op urinary incontinence?
Median disease-free interval?
MST?

A

Bennett, Vet Surg, 2018:
60% TCC, 32% adenocarcinoma, 4% undifferentiated carcinoma, 4% papillary cystadenocarcinoma
4% had nodal metastasis
60% minor complication rate, 16% major complication rate
35% had permanent post-op urinary incontinence
Median DFI: 82 days
MST: 231 days

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15
Q

Place
Hormones for Ovarian Remnant Syndrome
JAVMA 2019

A

Combined
~Anti-Mullerian hormone
~Progesterone

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16
Q

Ogilvie
Silver coated Urinary catheter
JAVMA 2018

A

Factors associated with bacteriuria
~Older age
~Longer duration of catheterization

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17
Q

Berent
SUB
JAVMA 2018

Post op complications

Survival to discharge

Catheter mineralization

A

Post-op complications
~Device occlusion with a blood clot 8%
~Device leakage 4%
~kinking of the tubing 5%

Survival to discharge 94%

Catheter mineralization 24%

18
Q

Corriveau
Lap OVE & Lap OHE in dogs
JAVMA 2017

A

SSI 1%

Urinary Incontinence
~OVE 6%
~OHE 15%

19
Q

Deroy
Pigtail and SUB
JAVMA 2017

A

Mortality
~Stent 18%
~SUB 13%

Device occlusion
~Stent 26%
~SUB 4%

Repeat Procedures
~Stent 44%
~SUB 9%

MST
~Stent 14m
~SUB not reached

Median durations of surgery and hospitalization were significantly longer in the stent versus UB group.

Stent placement associated with a greater risk of lower urinary tract–related signs

~hematuria 52%

~pollakiuria or stranguria 48%

20
Q

Kulendra
Complications with SUBs
JSAP 2021

A

10% in hospital mortaility

Survival associated with creatinine 440 μmol/L
~above survived 530 d
~below survival 949 d

Major complications occurred 48%

21
Q

Plater
Tx of ureter injury with OHE
JSAP 2020

A 
Outcomes in operated patients
Excellent 68%
Good 5%
Fair 5%
Poor 22%

44% major complications requiring additional surgery

22
Q

Segal
Urethral orifice in PU
JSAP 2020

A

Stricture 20% cats

Associated with 8F
< 44%
> 6%

23
Q

Charlesworth
Lap vs Open OVE
JSAP 2019

A

Complications
~Open 44%
~Lap 20%

24
Q

Florey

Cystine Uroliths and Neuter Status

JSAP 2017

A

Intact dogs odd ratio 4.5 x

25
Q

Kopecny

Uroliths in Dogs

JVIM 2021

A

47% CaOx decreased 50 to 42%

44% Struvites no change

3% Cystine increased 1 to 9%

~70% intact males

26
Q

Kopecny

Uroliths in Cats

JVIM 2021

A

CaOx Decrease 50 to 38%

Struvites Increased 42 to 55%

Urates 3rd most common 9%

27
Q

Shivley

Sharp Transection of Suspensory Ligament

VetSurg 2019

A

Sx time 1.1 min faster for sharp

1 kg increased Sx time by 0.1 min

Heart rate increase from baseline 7.4 bpm lower in sharp dissection

28
Q

Sousa-Filho FJMS 2020

Overall complications of PU and PPU?

Recurrent UTI PU and PPU?

Urine scald dermatitis PU and PPU?

A

Overall complications
PU 32%
PPU 83%

Recurrent UTI
23% vs 67%

Urine scald
5% vs. 83%

29
Q

Seneviratne JFMS 2021:PPU

Short term complications overall?

Long term complications overall?

Long-term complications was greatest in which group?

What were those complications?

Short-term mortality overall?

Long-term mortality overall?

A

Short-term complications overall
~60%

Long-term complications overall?
37%

Long-term complications were greatest in which group?
PPU

What were those complications?
incontinence

Short-term mortality overall?
6%

Long-term mortality overall?
13%

30
Q

Pennington FJMS 2021:SUBs

Rate of post op infection
1 month
1 year

What was associated with positive culture at 6 months?

What % or positive pre-op culture had positive PO culture at 1 year?

What was associated with decreased odds of positive culture at 3 months?

What bacteria was associated with implant removal?

A

Rate of post op infection
1 month: 9%
1 year: 24%

What was associated with positive culture at 6 months?
-positive pre-op culture (odds ratio 4)

What % or positive pre-op culture had positive PO culture at 1 year?
~43%

What was associated with decreased odds of positive culture at 3 months?
~Higher end of anesthesia rectal temperature

What bacteria was associated with implant removal?
~E. coli

31
Q

Vrijsen FJMS 2021: SUBs

Overall complication rate?

Death prior to discharge?

Revision surgery?

MST?

What was an increased risk for developement of preoperative complications?

What was associated with less likely to survive to discharge?

What was associated with short term complications?

A

Overall complication rate?
~80%

Death prior to discharge?
~21%

Revision surgery?
~25%

MST?
~274d

What was an increased risk for the development of preoperative complications?
~increased age

What was associated with being less likely to survive to discharge?
~increased age

What was associated with short-term complications?
~increased HCT at presentation

32
Q

Perry JVECC 2021
Urosepsis

Overall survival to discharge?

Most common bacteria?

What was different between survivors and non-survivors?

A

Overall survival to discharge?
87.5%

Most common bacteria?
E. coli
Klebsiella
Staph pseud

What was different between survivors and non-survivors?
more dysfunctional organs

33
Q

Wuillemin JVIM 2021

SUBs

Survival to discharge?

Change in Creat?

Kink of device noted in what %?

Time to luminal obstruction?

Time to kink?

Patients requiring revision?

MST?

Cause of death in 52% of cases?

A

Survival to discharge?
94%

Change in Creat?
5.3 to 2.1

Kink of device noted in what %?
10%

Time to luminal obstruction?
204 d

Time to kink?
58 d

Patients requiring revision?
17%

MST?
821 d

Cause of death in 52% of cases?
Urinary related

34
Q

Dekerle Vet Surg 2022
Female dogs with ectopic ureters

Rate of 1 month PO continence?

Overall remained continent for how many months?

How many achieved continence with adjunct treatment?

Fewer complications and incontience noted in what procedure?

A

Rate of 1 month PO continence?
80%

Overall remained continent for how many months?
66 months

How many achieved continence with adjunct treatment?
88%

Fewer complications and incontience noted in what procedure?
CLA than neoureterostomy

35
Q

Bresciani Vet Surg 2021

Early postoperative complication in modified PPU?

A

Early postoperative complication in modified PPU?
skin scalding

36
Q

What did Fremonts et al JAVMA 2017 conclude about the use fo poliglecaprone 25 for perineal urethrostomy in cats?

A

It is an appropriate suture
18% minor short term complications
42% minor long term complications
1.6% major short term complication - one cat developed a stricture

37
Q

What did Nye et al JAVMA 2020 conclude about dorsal vs ventral positioning for feline PU surgery?

A

No difference in duration of surgery or anesthesia, even when cystotomy performed.
Surgeon preference

38
Q

Pavia et al JAVMA 2018
What is the importance of urinary tract infections for dogs treated with stents for ureteral obstructions?

A

UTI present in 59% of patients prior to stunting and 26% after stunting
28% of patients with positive urine culture prior to stent placement have recurrent UTIs that won’t clear

39
Q

What did DeRoy et al JAVMA 2017 conclude about long term outcome of cats treated with ureteral stents vs SUBS for ureterolithiasis?

A

Stent group - longer hospitalization, shorter MST, increased risk of device occlusion, increased risk of need for additional procedures

40
Q

Wormser et al JAVMA 2019
How useful is ultrasound for the detection of the cause and location of ureteral obstruction in cats?

A

Very good for uroliths, not very sensitive for strictures

41
Q

According to Grimes et al JAVMA 2018 what percentage of dogs survived to hospital discharge following uroabdomen?

A

79%

42
Q

Hamlin et al VetRad 2019
What are the common ultrasound findings of feline TCC?

A

singular, broad-based mass within the mid-body or apex of the urinary bladder.
Urethral extension of the tumor less likely in cats vs dogs

ACVS Phase II 2023 Case Based Only (22 decks)

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