Urogenital Flashcards
1
Q
- What is tunica dartos? Action?
A
a. Smooth muscle that separates cavities and helps draw testes to abdomen / body
2
Q
- What is between outer/inner tunics?
A
a. “Vaginal cavity” – continuous with peritoneal cavity at external inguinal ring
3
Q
- What type of cells do you see on cytology during estrus?
A
a. Keratinized cornified epithelium, superficial cells
b. Some bacterial flora
c. Should NOT see neutrophils (except in diestrus)
4
Q
- Give origin / insertion of each muscle and general location on penis
a. Retractor penis
b. Ischiocavernosus
c. Bulbospongiosus
d. Ischiourethralis
A
a. Retractor penis – smooth muscle caudal half with external anal sphincter – ventral surface insert on penis at level of preputial fornix
b. Ischiocavernosus
i. O: ischial tuberosity
ii. I: proximal corpus cavernosum
c. Bulbospongiosus
i. O: from tunica albuginea and EAS covers bulb of penis; fuse with retractor peenis at 1/3 of body
d. Ischiourethralis
i. O: dorsal ischial tuberosity
ii. I: fibrous ring at urethral bulb
5
Q
- Where do proper ligament of testis & ligament of tail of epididymis attach?
A
a. Epididymal tail to testis
b. Testis / epididymis to vaginal tunic & spermatic fascia
6
Q
- Describe lymph & nervous systems of prostate
A
a. Lymph: medial iliac + hypogastric chain of nodes
b. Nerves:
i. Fluid excretion / secretion: cholinergic post-ganglionic hypogastric (S)
ii. Smooth mm contraction: adrenergic post-gang hypogastric (S)
iii. +/- parasymp pelvic n to increase rate secretion
iv. Stromal tissue: nonadrenergic to control smooth mm tone, several NTS
7
Q
- What is diameter of feline ureter? Dog ureter?
A
a. Feline: 0.4 mm
b. Dog: “0.07 x length of L2 body” (studies show 2-2.5 mm on CT)
8
Q
- Describe vascular & nerve supply to ureter
A
a. Vascular: Ureteral a from caudal aspect of renal a ureteric branch of caudal vesicular a
b. Nerve: ANS – PS/S from pelvic plexus; S – celiac plexus
9
Q
- What are macula densa?
A
a. Cells outside of glomerulus that maintain autoregulation of blood flow
10
Q
- What size particles filter in glomerulus?
A
a. <60,000 Daltons
11
Q
- What charged molecules can’t filter in glomerulus?
A
a. Negative (like albumin)
12
Q
- What is normal urine production?
A
a. 20-45 ml/kg/day
13
Q
- What % of cardiac output is through kidney at all times?
A
a. 25%
14
Q
- During embryonic development, what is cranial vagina formed from?
A
a. Paired paramesonephric (Mullerian) ducts
15
Q
- What is the genital tubercle?
A
a. Analogous to penis or vaginal clitoris (lots of nerve endings)
16
Q
- What is the uterine ostium?
A
a. The opening of uterine tube to the uterine body (acts like sphincter)
17
Q
- What is different about the cat with respect to ovarian tube?
A
a. Tube tortuous and can be seen within mesosalpinx
18
Q
- When does mucosal healing occur in bladder?
A
a. 5 days
19
Q
- How long until 100% bladder tissue strength?
A
a. 14-21 days
20
Q
- What are the accessory sex glands of dogs vs cats?
A
a. Dog: prostate
b. Cat: bulbourethral gland (thick mucous) + prostate (alkaline fluid for survival of sperm)
21
Q
- Describe the blood supply, LN, nerves to vagina/vestibule, vulva
A
a. Arteries:
i. Vagina, urethra, vestibule – vaginal a from internal pudendal
ii. Vulva – external pudendal
b. Venous: same as arterial
c. LN:
i. Vagina/vestibule – internal iliac LN
ii. Vulva – superficial iliac LN
d. Nerves:
i. PS – pelvic
ii. S – hypogastric
iii. Sensory – pudendal
22
Q
- Describe innervation and micturition reflex
A
a. Urine fill / retention -> sympathetic via hypogastric
i. + alpha at IUS to contract
ii. + beta 3 on detrusor – relaxes detrusor
b. Urination – full bladder – stretch on m3 receptor – afferent pelvic – pontine contract
i. Parasym via pelvic n – binds m3 to contract detrusor – pees
ii. Inhibits pudendal & hypogastric
1. Pudendal – somatic efferent to m3 on external urethral sphincter
See fig 116.3 bladder
23
Q
- What is contained in spermatic cord?
A
a. Ductus deferens (ductus a/v), testicular a, pampiniform plexus, lymph, nerves, cremaster m
24
Q
- What forms spermatic fascia?
A
a. Transversalis, superficial / deep abdominal fascia
25
25. What forms cremaster m? Action?
a. IAO, transversus abdominus
b. Raises / lowers testes
26
26. Average size of dog / cat ovaries?
a. Dog: 15 x 7 x 5 mm
b. Cat: 8-9 mm long
27
27. What is the vaginal process?
a. Peritoneal fold that encloses round ligament as passes through inguinal canal
28
28. Vascular, LN, nerve supply to ovaries?
a. Ovarian a from aorta
b. R ovarian V -> Cd VC
c. L ovarian V -> L renal V
d. Lumbar LNs
e. Sympathetic division of ANS
29
29. Describe vasculature, nerve, and lymph supply to testes / epididymis
a. Testes:
i. Testicular a from aorta
ii. Testicular V -> forms pampiniform flexus
1. R testicular V drains into -> Cd VC
2. L -> L renal V + ductus deferens vein
b. Epididymis:
i. Ductus deferens a - branch of prostatic a – arises from branch of internal iliac
c. Nerves: testicular (internal spermatic plexus)
i. Epi (L4-L6 ganglia of sympathetic trunk)
d. Lymph: lumbar LN
30
30. What are main differences between feline & canine reproductive cycles?
a. Feline: seasonally polyestrus (+/- 5th “nonestrus” phase)
i. Vulva not responsive to estrogen
ii. CL requires induction of ovulation via copulation (CL functional 37 d in non-preggo cats)
iii. Bone mineralization seen 25-29 days before birth (week earlier than dogs)
iv. Placental secretion of progesterone independent of ovaries – occurs after day 40
31
31. Where do preputial muscle originate? Insert?
a. O: xiphoid cartilage
b. I: dorsal wall of prepuce
c. Derived from cutaneous trunci
32
32. What maintains normal prostate lot (secretion?)?
a. Androgens
33
33. What breeds already have prostate in abdomen from birth (to adulthood)?
a. Chondrodystrophic
34
34. What are colliculis seminalis?
a. Slits where prostate gland ejaculation ducts enters prostatic urethra
35
35. What point in growth is prostate development most marked?
a. 20-32 week of age
36
36. Where are the nephrons impermeable to urea?
a. Thick look of Henle
b. Distal tubules
c. Cortical collecting ducts
d. Can be partly absorbed in PCT (medullary collecting tubules?)
37
37. What can you give to tx hyperkalemia for urethral obstruction?
a. If ECG changes or K > 8
i. Ca gluconate 0.5-1.5 ml/kg IV over 5-10 min
ii. Dextrose + insulin
iii. IVF diuresis the best start
38
38. What is relative concentration of renal medullary interstitium vs cortical? Hypertonicity created by __?
a. 1200-1400 mOsm/L vs 300 cortex
b. Diffusion of urea into interstitium at CD (gives 50% of osmolarity)
c. Limited ability of water to diffuse into interstitium (only descending loop)
d. Active transport of Na, K, Cl from thick portion of loop of Henle
39
39. What are the 4 phases of estrus cycle & what are the prominent hormone changes here?
a. Proestrus – 9 days – estrogen elevation & follicle maturity
b. Estrus – 9 days – LH surge as estrogen decreases; also progesterone starting to rise; ovulation w/I 2-3 days after LH surge
c. Diestrus – 60 days – where stays in pregnancy if fertilized; increase progesterone levels
d. Anestrus – 4.5 months – low levels of everything; slow rise of estrogen towards pro/estrus?
40
40. Urethra blood supply & innervation?
a. Nerve: PS (pelvic); S (hypogastric) – smooth m
i. Pudendal – somatic – striated
b. BS: branches of internal pudendal
i. Prostate – urethral
ii. Vaginal – urethral
41
41. What are changes seen on ECG with hyperkalemia from blocked urethra?
a. Spiked T to depress R wave
b. Prolonged QRS and PR intervals
c. ST segment depression
d. Smaller/ wider P with long QT interval
e. Atrial standstill
f. Wide QRS
g. Ventricular arrhythmias
42
42. What are 3 stages of parturition and what are guidelines or concerns?
a. 1: Uterine contractions present ~24 hours, nesting behaviour, etc
b. 2: Expel fetus
c. 3: Expel placenta
d. Active strain <= 30 min before birth; time lab between puppies <4 hours
43
43. 3 major types of cells of testes and roles
a. Spermatogenic cell – form the sperm
i. Mitosis --> spermatocytes --> meiosis to spermatids
b. Sertoli cells – “nurse or sustentacular cells”
i. Nourish and support development of spermatozoa
ii. + by FSH (from the anterior pituitary gland), produce inhibin
iii. Pituitary inhibits FSH; Inhibin inhibits FSH (negative FB)
c. Leydig cells – produce testosterone
i. Dependent on negative feedback with LH
44
44. What are factors that help keep scrotum / testes cool?
a. Cremaster + tunica dartos contracts
b. Rich in sweat glands
c. Little SQ fat
d. Few hair follicles
e. Pampiniform plexus cools blood
45
45. What is blood supply, nerves, lymph for scrotum?
a. External pudendal a scrotal a
b. Scrotal V
c. Nerves: superficial perineal n – branch of pudendal (S1-S3)
i. Tunica dartos inn by post ganglionic sympathetic trunk from superficial perineal n
1. NOT PELVIC PLEXUS
d. Lymph: Superficial inguinal LN
46
46. Describe the muscular layer of ureter
a. tunica muscularis = Inner & outer longitudinal, middle circular layers
b. Pitch of muscle fibers = circular proximally
i. Oblique toward mid-length
ii. Longitudinal distally
47
47. What are the 2 mechanisms of developing an erection?
a. Engorgement of cavernous bodies by expansion of arteries / contraction of veins
b. Distal penile vein compressed against ischial arch by contraction of ischiocavernosus and bulbospongiosus muscles
48
48. Describe blood supply and lymph of bladder
a. Caudal vesical a – prostatic / vaginal internal pudendal
b. Cranial vesical a – from umbilical
c. Internal pudendal v
d. Lymph: hypogastric & sublumbar LN
49
49. Describe vascular supply of kidneys
a. Renal a (left +/- 2) “The left kidney is more likely to have multiple renal arteries than the right kidney. Some single renal arteries branch immediately after leaving the aorta, making it appear that the kidney has two renal arteries”
i. Renal a splits into dorsal and ventral ranches at hilus
ii. Then branch into Interlobar – arcuate (corticomedullary junction) – interlobar – afferent – efferent
iii. Small capsular a – from phrenicoabdominal / adrenal
iv. Vasa recta – wrap around nephron
b. Venous
i. Deep & superficial v within renal parenchyma – stellate – interlobar – arcuate – renal v – CdVC
ii. Left renal V also gets blood from L ovarian or L testicular V
50
50. What are the functions of the prostatic secretions? What is it composed of?
a. Promote sperm motility
b. Increase uterine perfusion
c. Modulate neutrophil induced inhibition of spermatozoa attachment to uterine epithelium
d. pH 6.1-6.5, PGE2, Na, K, Cl, + Zn, acid phosphatase + esterase
e. in 3rd fraction of ejaculation
51
51. Gestation length dogs / cats?
a. Dogs: 64 days
b. Cats: 66 days
52
52. When are fetal skeleton detected on rads dogs / cats?
a. Dogs: day 42 (21-24 days before parturition)
b. Cats: 25-29 days before parturition
53
53. When does attachment occur in dogs / cats?
a. Dogs: 21-22 days post LH surge
b. Cats: 15 days after coitus
54
54. What are the changes in bloodwork commonly seen during pregnancy in dogs?
a. Anemia ~<40% at 35 days, <35% at term
b. Mild increases in WBC, cholesterol
c. Decreased protein
d. Increased glucose – insulin resistance
e. Progesterone – decreases 18-30 hours pre-partum
55
55. Describe vascular supply to prostate
a. Internal pudendal – prostatic a -> arteries of ductus deferens - caudal vesical, caudal rectal
b. Anastomoses between Prostatic a – urethral a – cranial & caudal rectal a
c. Cranial / middle / caudal branch – subcapsular a -> supplies glandular tissue
d. Parenchyma, capsular, and urethra vascular zones
e. Venous:
i. Prostatic v & urethral v -> internal iliac v
ii. Prostatic urethra -> prostatic v, v of urethral bulb, ventral prostate veins
56
56. What is the nerve supply to penis? Lymph nodes?
a. Pelvic & sacral plexuses; dorsal n of penis – chief sensory n
b. Superficial inguinal LN
57
57. Describe the vascular supply, lymph centers, and nerve supply to uterus
a. Uterine arteries
i. Branch of vaginal – branch of internal pudendal – branch of internal iliac
b. LN: hypogastric & lumbar
c. N: pelvic plexus S – hypogastric; PS – pelvic
58
58. What are proposed reasons estrogen helps with BPH development?
a. Increased sensitivity of prostate to dihydrotestosterone by inducing nuclear dihydrotestosterone receptors
b. Inhibitory effect on rate of cell death?
59
59. Describe the differences between glandular and complex form of BPH?
a. Glandular:
i. Testosterone metabolized by 5 alpha reductase dihydrotestosterone
ii. Structure and arrangement remain orderly and organized at stage
iii. Increased androgen receptors (maybe less cell death?)
b. Complex:
i. Stromal elements – asymmetric enlargement
ii. Areas of atrophy, cystic alveoli with eosinophilic materials & inflammatory cells
60
60. What are main differences between urethra of male / female dogs / cats?
a. Male dog:
i. No pre-prostatic urethra
ii. Thick circular striated surrounds long smooth in distal 2/3
iii. Long penile component
b. Male cat:
i. Distinct pre-prostatic
ii. Pre and post-prostatic urethra 2mm diameter (prostate)
iii. Bulbourethral glands 1.3 mm
iv. Penile 0.7 mm
v. 3 layers of smooth muscle fibres of preprostatic urethra
vi. Striated (urethralis) muscle short functional length
c. Female dog:
i. Short / wide 0.5 cm
ii. A lot more collagen!
iii. 3 smooth layers
iv. Interdigitate with striated muscle distal 1/3
v. Sphincter of voluntary striated mm at external urethral orifice.
d. Female cat:
i. Smaller lumen than dog
ii. Urethral wall lot more longitudinal smooth & less striated mm
61
61. What are the origins / insertions & what are they intimately associated with?
a. Corpora cavernosa
b. Corpus spongiosum
c. Bulbus glandis
a. Corpora cavernosa
i. Ishial tuberosity dorsal to os penis
ii. Covered by tunica albuginea
b. Corpus spongiosum
i. Within pelvic cavity – surrounds penile urethra
ii. Also shunts blood to bulbus glandis
c. Bulbus glandis
i. Proximal part of os penis
ii. Separated from longa glandis (distal)
iii. Expands way more than long glandis for erection
62
62. What % spays get complications?
a. ~7.9-19% (mostly minor)
63
63. What are options for port locations for OVE/OVH?
a. Transabdominal – all midline
b. Transabdominal – midline + cranial R side
c. Transabdominal – paramedial ports (instruments)
i. All 3 or 2 port
d. Combi – transabdominal + transvaginal
e. Single port transabdominal
64
64. Vessel sealing devices only use on uterus < __ mm
a. 9 mm
65
65. When do you perform laparoscopic artificial insemination (as in bloodwork with cytology)?
a. Progesterone 4-8 ng/mL; when >= 80% superficial cells on vaginal cytology
66
66. What does low serum LH in bitch indicate?
a. Intact status; OR ovarian remnants if spayed <10 days ago
67
67. What does chronic increased plasma estrogen indicate?
a. Follicular cysts
b. Estrogen producing tumors
68
68. What bloodwork changes come with leutinized follicular cysts?
a. Increased progesterone with normal estrogen conc and no signs of proestrus or estrus
69
69. What are advantages of scrotal urethrostomy in male dogs?
a. More superficial, wider, less hemorrhage
b. Less urine scald / UTI / incontinence with others
70
70. What are urethrostomy options for females?
a. Subpubic & prepubic
71
71. What is complication rate for perineal urethrostomy in cats?
a. Newer studies 12-15%
72
72. List surgical techniques for urethrostomy in cats
a. Perineal
b. Transpelvic
c. Subpubic
d. Prepubic
73
73. Which has increased rate of complications?
a. Prepubic
74
74. Prognosis for urethral R&A?
a. Guarded prognosis
75
75. What is epispadias? What could happen with it?
a. Failure of fusion of dorsal penile urethra --> bladder exstrophy
76
76. What breeds at risk for urethral prolapse?
a. Brachycephalic; English Bulldog
77
77. What are tx options for urethral prolapse?
a. Castration
b. Phallopexy
c. Urethral R&A
d. Reduse + purse string
e. Treat BOAS
78
78. Recurrence rates of urethral prolapse post sx? What should you be giving post-op to help decrease?
a. 50-60%; sedation with ace/butorphanol
79
79. List suspected factors affecting causes of USMI
a. Urethral tone & length (shorter)
b. Bladder neck position (pelvic bladder)
c. Body size & breed (overweight, longer breeds)
d. Gonadectomy (affect collagen levels?)
e. Hormonal status (decreased estrogen)
f. Genital conformation (vestibulovaginal stenosis)
80
80. List treatment options for USMI and their success rates
a. Sympathimomimetics or parasympatholytics ~50% alone
i. Estrogen ~50%
ii. Alpha agonist phenylpropanolamine
b. GnRH analogues (decrease pituitary release LH/FSH) ~50-83%
c. Colposuspension ~53-55%
d. Urethropexy / cystourethropexy 56%
e. Bulking agents
f. Transpelvic urethral sling
g. Transobturator vaginal tape
h. Artificial urethral sphincter 33-45%
81
81. What is % continence rate for urethropexy + colposuspension?
a. 70%
82
82. What is complication rate of urethropexy?
a. 21%
83
83. What substance is used for a bulking agent?
a. Bovine collagen
84
84. What is complication rate for transobturator vaginal tape?
a. 33%
85
85. For artificial urethral sphincter, what is it made of?
a. Silicone
86
86. What is the artificial urethral sphincter implant size based on?
a. Luminal diameter of closed cuff
87
87. To avoid obstruction, should be __% of urethral circumference.
a. 50%
88
88. What is complete continence rate for this surgery?
a. 36-56%
89
89. UTI rate?
a. 63%
90
90. What immunosuppression drug is not OK for dogs with renal transplants?
a. Tacrolimus – more severe side effects
91
91. What method is the choice for monitoring cyclosporine concentration?
a. HPLC method – measures parent compound
92
92. What is formulation of choice for cyclosporine and why?
a. Neoral 100 mg/ml
b. Microemulsified formulation; better GI absorption and sustained blood levels
c. More predictable
d. 1-4 mg/kg q12
93
93. What are the goal cyclosporine target levels?
a. 300-500 ng/mL (eventually 250 ng/ml)
94
94. What is current immunosuppressive protocol for canine kidney transplants?
a. Cyclosporine (Neoral) 2-5 mg/kg PO q12
b. Prednisolone 1 mg/kg/d PO
c. Azathioprine 3-5 mg/kg PO q48
95
95. With the donor cat/dog (renal transplant) when is mannitol given?
a. At time of incision and 20 min before nephrectomy
96
96. What drug for analgesia in dogs to avoid and why?
a. Morphine – concern for intussusception
97
97. What is the kidney graft store in between procedures?
a. Ice cold phosphate-buffered sucrose organ preservation solution
98
98. What are the former and newer anastomosis sites of renal transplantation in cats?
a. Former: External iliac a/v
b. Newer: Aorta; then CdVC
99
99. What was the problem of former technique of renal transplantation in cats?
a. one report using this technique, ~12% of cats developed some form of pelvic limb complications, including pain, limb edema, hypothermia, paresis, or paralysis
100
100. List 3 neoureterocystostomy techniques used
a. Intravesicular mucosal apposition
b. Extravesicular
c. Ureter + papilla excised and anastomosis with bladder (extravesicular)
101
101. Two methods of pexy of donor kidney?
a. Allograft pexy to wall or musculoperitoneal flap (base ventral) suture to capsule
102
102. What percent canines get intussusception post renal transplant?
a. 25%
103
103. What is hemolytic uremic syndrome?
a. Side effect of cyclosporine therapy (cats)
b. Hemolytic anemia, thrombocytopenia, rapid deterioration of renal function secondary to glomerular & renal arteriolar platelet & fibrin thrombi
104
104. What is mortality rate with hemolytic uremic syndrome?
a. 100%
105
105. What is incidence of acute rejection in cats?
a. 13-26%
106
106. What are methods of diagnosis of acute rejection?
a. AUS +/- contrast enhancement,
b. CS
c. Urine sediment stones / minerals?
107
107. Tx for acute rejection in cats?
a. IV cyclosporine, prednisolone-Na-succinate IV, IVF
b. If no improvement evaluate for another cause
c. Newer sx? Euth?
108
108. List complications with kidney transplants in cats vs dogs
a. Cats: acute rejection, chronic rejection, hemolytic uremic syndrome, Ca oxalate urolithiasis, retroperitoneal fibrosis, ureteral obstruction, infection, diabetes mellitus, neoplasia
b. Dogs: thromboemboli, intussusception, infection, graft rejection, renal dysfunction, cardiac failure, neurotoxicity, ocular toxicity, hepatotoxicity, gingival hyperplasia
109
109. MST for renal transplants
a. Cats: 360-613 days
b. Dogs: 24 days (0.5-4014 d)
110
110. Diagnostic options for ovarian remnant syndrome
a. Hormone – estradiol / progesterone
b. LH concentration
c. Anti-mullerian
d. AUS
e. CT
111
111. What do you have to do with cats for evaluating progesterone?
a. Needs luteinization hCG or GnRH then measure 5-7 days after giving
112
112. On abdominal palpation of uterus, when are fetuses more palpable?
a. Day 50
113
113. Progesterone causes pyometra how?
a. Increases endometrial glandular secretion & suppress contractions of uterus
b. Also decreases proliferative response of mononuclear cells indicating immune suppression
114
114. What might be a reason for anemia with pyometra?
a. Anemia – lactoferrin and others mediate iron sequestration within myeloid cells in bone marrow, withdrawing Fe from normal EPO
115
115. What % cases of pyometra get glomerular damage?
73%
116
116. What is most common cause of dystocia
a. Primary inertia 72% days
117
117. Treatment for dystocia?
a. Oxytocin (0.2 U/5 kg) IM or SQ q30 minutes – if no progress after 2 surgery
b. Ca gluconate + glucose controversial
118
118. What is % success rate med mgmt alone for dystocia
a. 30-40%; 60-65% need C section
119
119. What progesterone level suggests birth happening soon?
a. <2 ng/ml
120
120. What is tx of secondary inertia?
a. Surgery, not medical mgmt.
121
121. For planned C-section, when is it planned?
a. 63-65 days post LH surge; or when late gestational serum progesterone <2 ng/ml
122
122. What drugs are associated (with relation to anesthesia) with increased puppy mortality rate?
a. Methoxyflurane or xylazine
123
123. With low fetal heart rate, what can be given? (still in womb, so giving to dam)
a. Atropine; glycopyrrolate – doesn’t cross placenta!
124
124. If bradycardia with fetus once delivered? What do you give?
a. Start with oxygen therapy!! Then epi if needed
125
125. List 2 approaches to vagina
a. Episiotomy
b. Ventral
c. Combined abdominal + perineal approach
126
126. List types of vestibulovaginal stenotic lesions
a. Focal hypoplasia
b. Imperforate hymen
c. Vertical septum
d. Double vagina
127
127. List vestibulovaginal stenosis treatment options
a. Episiotomy – excise septum
b. Vaginoplasty / resection
c. Vaginal R&A
d. Severe or stenosis >2cm cranial to vestibulovaginal junction – vaginectomy
128
128. What % of vaginal neoplasias are benign?
a. 73-84%
129
129. What is the surgery approach for wide resection of vaginal / vulvar / vestibular tumors? What is its limitation?
a. Vulvovaginectomy & perineal urethrostomy through caudal approach
b. ONLY if caudal to cervix
130
130. What test (blood) alone to rule out bilateral cryptorchid vs anorchid?
a. Testosterone
131
131. What age is when testes descend?
a. 30-40 days
132
132. When (age) can you definitively diagnose cryptorchid?
a. 6 months
133
133. List breeds with cryptorchidism
a. Chihuahua, Mini schnauzer, Pomeranian, Poodle (mini, toy, standard), Shetland sheepdog, Husky, yorkie, Cat – persians
134
134. What are primary vs secondary scrotal tumors?
a. Primary: MCT, melanoma, vascular hamartomas, HSA, hemangiomas, histiocytomas, papillomas, fibroma/sarcoma, SCC, adenocarcinoma, apocrine gland tumors
b. Secondary: Sertoli cell, interstitial
135
135. List breed predispositions for scrotal neoplasias
a. MCT: Pitties, Boxers, beagles, boston, vizslas
b. Melanoma: Schnauzers, goldens
c. Vascular hamartomas: Bassets, Boxers
d. Histiocytomas: Beagles, Boxers
e. HSA / Hemangiomas: Goldens, Boxers
136
136. List approaches for vasectomy
a. Inguinal
b. Open caudal midline abdominal
c. Abdominal laparoscopy-assisted
d. Prescrotal or scrotal incision (separate on test?)
137
137. What are majority complications listed for cryptorchid castrations
a. Prostatectomy
b. Partial prostatectomy
c. Urethral / ureteral avulsions
138
138. What has been the length of time reported for sperm persisting after vasectomy?
21 days
139
139. What is hypospadias? Breed predisposed? Treatment?
a. Failure of fusion of urogenital folds – incomplete formation of penile urethra & external orifice even more caudal
b. Boston
c. Recon NOT done
i. Excise preputial / penile remnant
ii. Bilateral orchiectomy
iii. Enlarge urethral orifice
140
140. What is indication for preputial shortening?
a. When large part of glans penis removed
141
141. What breeds seen with persistent penile frenulum?
a. Cocker spaniel
b. Mini poodle
c. Pekingese
142
142. Surgical options with penile tumors?
a. Partial penile amputation
b. Penial amp / ablation + scrotal urethrostomy
143
143. Difference between paraphimosis vs phimosis? Prognosis of each?
a. Paraphimosis – penis protrudes, cant replace guarded
b. Phimosis – cant protrude penis past orifice good
144
144. Surgical treatment options for paraphimosis?
a. Temp or surgical enlargement of preputial orifice
b. Phallopexy (+/- preputial advancement)
c. Partial penile amp
d. Penile amp
145
145. Surgical options of preputial hypoplasia?
a. Remove open prepuce, partial penile amp, scrotal / perineal urethrostomy
b. Preputial advancement (guarded)
146
146. What are tx options for prostatitis / abscesses?
a. Ablation of secretory function + abx
b. Stoma drainage (marsupialization)
c. Passive drainage (penrose)
d. Active drainage
e. Partial prostatectomy
f. Omentalization
147
147. What antibiotics work best to get through lipid barrier of prostate?
a. Enrofloxacin
b. Marbofloxacin
c. TMS
d. Chloramphenicol
148
148. What has been reported to be inserted into abscess with US guidance?
a. Alcohol
149
149. Describe 2 forms of carcinoma classification of prostate?
a. First: Glandular, urothelial, squamoid, sarcomatoid
b. Second: (growth patterns) papillary, cribiford, solid, small acinar / ductal, signet ring, mucinous
150
150. What % of prostatic carcinomas get axial mets (skeletal)?
a. 20%
151
151. List treatment options for prostatic carcinomas
a. Tube cystotomy
b. Urethral stenting +/- prazosin
c. NSAID
d. Bisphosphonates
e. Total prostatectomy
f. Partial prostatectomy
g. RT – stereotactic or intensity modulated
h. Nd:YAG laser fillet + photo dynamic therapy
152
152. What lays along the dorsal prostate to care for with surgical approaches?
a. Vascular supply + hypogastric / pelvic nerves
153
153. How do you open capsule if bilateral prostate abscesses?
a. Use hemostat to wrap gently around and bluntly to open ALL cavities
154
154. What mortality rate of ventral drainage of prostatic abscesses?
a. 20%
155
155. Success rate for prostatic omentalization?
a. Overall good as long as ALL cavities bluntly dissected
156
156. What tool is helpful to perform partial prostatectomy?
a. Ultrasonic aspirator
157
157. Complications of partial prostatectomy?
a. Recurrence, urinary incontinence, hemorrhage
158
158. What is the difference between cat and dog prostate?
a. Feline prostate – bilobed
159
159. Prognosis for total prostatectomy for neoplasia?
a. Poor
160
160. On rads, normal canine kidney is __ x length of adjacent vertebrae; normal feline is __ x length of adjacent vertebrae
a. Dog: 2-2.5 x , Cats: 2-3 x
161
161. List imaging modalities to evaluate kidneys
a. Survey radiography
b. Excretory urogram (aka IV pyelofram)
c. Pyelography (direct injection pelvis)
d. US + Doppler US to look at resistance index
e. CT angiography
f. Dynamic CT
g. MRI angiography
h. Scintigraphy
162
162. What are 2 cautions with IV contrast studies?
a. Toxicity – iodine can cause renal toxicity
b. Kidneys with little functional capacity can opacify
163
163. Bolus injection – what is contrast dose?
a. 400 mg iodine / kg BW
164
164. Explain 3 phases of contrast execution?
a. 1st – renal angiographic – arterial supply to kidney (immediately after)
b. 2nd – renal phase “renal blush” – spreads through parenchyma
c. 3rd – excretory – flows collecting ducts transport to renal pelvis; then leaves/ transports to ureters
165
165. What are the times to take the images for IV pyelogram?
a. 5, 20, and 40 min after injection
166
166. What is equation for resistance index? What is normal value?
a. RI = [(peak systolic shift – minimum diastolic shift) / peak systolic shift]
167
167. What is comparison of dynamic renal scintigraphy to plasma clearance studies?
a. Dynamic RS less accurate to get GFR, but shorter sampling times
168
168. What are the 2 radiopharmaceuticals and which is better for GFR in limited renal function?
a. 99mTC-DTPA = diethylenetriaminepentaacetic acid (no secretion or tubular absorption)
b. 99mTc-MAG3 = mercaptoacetyltriglycine (secreted by renal tubules 90%) – better option!!
169
169. For renal patients, what drugs should be given for hypotension if not responding to fluids?
a. Dopamine or dobutamine
170
170. What is the difference between renal agenesis and dysgenesis?
a. Agenesis – no presence of ureter or kidney
b. Dysgenesis – no kidney BUT has ureter
171
171. What breeds get polycystic kidney disease - Cats vs dogs?
a. Cats – Persian cats (37% of this population); Ragdoll. British short hair, Scottish folds, Rexes, Chartreux
b. Dogs: Bull terrier
172
172. MST for renal HSA in dogs?
a. 278 days
173
173. What are tx options for renal trauma?
a. Wrap semielastic polyglactin mesh
b. Polyglycolid acid mesh
c. Usually – unilateral ureteronephrectomy
174
174. What is tx for idiopathic renal hematuria?
a. Local sclerotherapy with renal pelvic infusions of povidone-iodine and silver nitrate
175
175. What is the kidney worm? Tx?
a. Dioctophyma renale – ureteronephrectomy (no drugs effective)
176
176. Medical management options for feline ureterolithiasis?
a. Diurese!!! – Ca channel blocker
b. Glucagon
c. Amitriptyline
177
177. What are other options to treat feline ureteroliths?
a. Lithotripsy
b. Ureteral stent
c. SUB
d. Ureterotomy (?) – mortality – 18-21 so not really done
e. Ureteral resection + implantation
178
178. With SUBs, what is outcome?
a. 92% remain patent long term
179
179. What % SUBs get occluded from uroliths?
a. ~13%
180
180. What dog breeds are at higher risk with ureteral ectopia?
a. UK – Skye terrier, Goldens, labs
b. USA – Husky, Newfie, Bulldog, Westie, fox terrier, mini / toy poodles
181
181. Imaging options for diagnosing ectopic ureters?
a. Excretory urography
b. CT
c. US
d. Endoscopy
e. Fluoroscopy excretory urethrography
182
182. What are sx options for extramural vs intramural urethral ectopic ureters?
a. Intra – neoureterocystostomy (side to side)
b. Extra – ligate distal and reimplant (end to side neoureterocystostomy) = mucosal apposition technique
c. Both – cystoscopic laser treatment
183
183. What is success rate for surgical correction of ectopic ureter?
a. Resolution incontinence 22-72% (newer reports ~70-90%); another 7-28% with med mgmt
184
184. What is an alternative approach to do cystoscopic approach for ureteral ectopia in males?
a. Perineal approach to cystoscope placement
185
185. What are the types of ureterocele?
a. Orthotopic or intravesicular – if orifice in normal position and entire ureterocele within bladder
b. Ectopic – any portion within bladder neck/ urethra
186
186. Tx of ureterocele?
a. Urinary incontinence (UI) with ectopic – ureterocelectomy with or without neoureterocystostomy
b. If urethral obstruction without ureteral ectopia (& UI)
i. Ureterocelectomy without ureteral repositioning indicated
187
187. What are 2 methods of ureteral re-implantation (end to side neoureterocystotomy) – describe difference
a. Intravesicular – pull detached ureter into apex and spatulate, suture along inner bladder mucosa (knots intravesicular)
b. Extravesicular – place ureter (splatulated) along outer apex – place external knots to lumen
c. Also – papilla technique
188
188. What time frame does bladder mucosal defect regain 100% tissue strength?
a. 100% at 14-21 days
189
189. What is infection rate of bladder surgery?
a. 5%
190
190. What are suitable empiric abx for bladder sx?
a. Clavamox, 3rd gen cephalosporins, enrofloxacin
191
191. With respect to anesthesia, what are 2 issues with azotemia?
a. Can affect pharmacokinetics of drugs
b. Can interfere with platelet function
192
192. Which bladder stones are radiopaque?
a. Struvite, Ca oxalate, silicate
193
193. What are pHs (acid vs alk) of urine for struvite vs Ca oxalate vs urate vs cystine?
a. Struvite – alkaline
b. Ca oxalate – acid
c. Urate – acid
d. Cystine – acid
194
194. What are shapes of struvite vs Ca Oxalate?
a. Struvite – smooth, round, ellipsoid
b. Ca oxalate – jagged edges, sharp
195
195. List types of imaging studies to evaluate bladder
a. Positive contrast cystogram
b. Retrograde urethrocystogram
c. Double contrast cystogram
d. IV urogram
e. CT excretory urography
f. MRI
196
196. Where does mucosal regeneration come from in the bladder?
a. Trigone – so don’t resect!
197
197. For large bladder resections, what are augmentation techniques to assist in closure and bladder capacity?
a. Seromuscular colonic augmentation
b. Ileocystoplasty
c. Rectus abdominus flap
d. Diversion to prepuce or vagina
e. Porcine intestinal submucosa
198
198. What are options for cystostomy tubes recommended (short vs long term)
a. Foley / Mushroom-tipped catheters (de Pezzer) = short term
b. Low profile silicone human gastrostomy tube
199
199. List examples of congenital bladder abnormalities
a. Vesicourachal diverticula
b. Patent urachus
c. Bladder hypoplasia
d. Genitourinary dysplasia (cats)
200
200. What volume is infused and for how long for peritoneal dialysis?
a. 20 ml/kg – 45 min
201
201. What is a risk factor for getting Ca oxalate?
a. Hypercalcemia
202
202. What % plain films get false negative for presence of stones?
a. 25-27%
203
203. List tx options for cystoliths
a. Med mgmt:
i. Catheter assisted retrieval
ii. Transurethral cystoscopic retrieval
iii. Voiding hydropulsion
iv. Lithotripsy
v. Laparoscopic assisted or percutaneous cystotomy
b. Surgery: cystotomy
204
204. What should you test before doing lap assisted?
a. Urine culture! Don’t want leakage of infected urine
205
205. For lithotripsy, what type of laser used?
a. Ho:YAG
206
206. What breeds are predisposed to lower UT tumors?
a. Airedale terriers
b. Beagles
c. Shelties
d. Collies
e. Scottish terriers
207
207. List associated factors with development of TCC
a. Female
b. Obesity
c. Older topical insecticides
d. Phenoxy herbicines
e. Nitrosamine exposure
f. Cyclophosphamide exposure
g. Live in area of industrial activity
208
208. List tx options for TCC
a. Chemo
b. NSAIDS (piroxicam)
c. Low-dose metronomic chemo chlorambucil
d. Palliative cystostomy tube
e. Partial cystectomy
f. Transurethral cystoscopic laser ablation
g. RT
h. Urethral stent
209
209. What is met rate to TCC?
a. 10-40% (not sure where these are from.. Tobias has different # for diff areas)
210
210. What are ECG changes for hyperkalemia?
a. Spiked T waves and depressed R waves
b. Prolonged QRS and PR intervals
c. ST segment depression
d. Smaller and wider P waves with prolonged QT intervals
e. Atrial standstill
f. Wide QRS complex and ventricular arrhythmias
211
211. How long is urinary diversion recommended for after urethral R&A?
a. 3-5 days
211
212. What is different between closure method options of prepubic and perineal vs prescrotal?
a. Prescrotal – option of 2nd intention healing
212
213. What are the 3 branches of the artery of the penis and what do they supply?
a. All from internal pudendal
b. Artery of bulb – corpus spongiosum, urethra, pars longa glandis
c. Deep a of penis – corpus cavernosum
d. Dorsal a of penis – corpus spongiosum, bulbus glandis, pars longa glandis
213
214. What are the 4 veins of the penis and what do they drain and where to?
a. Dorsal v of penis – drains bulbus glandis --> internal pudendal
b. Deep / superficial v of glans – drains pars longa --> external pudendal
c. Deep v of penis – drains corpus cavernosum
d. V of urethral bulb – drains corpus spongiosum
e. --> both go to internal pudendal
214
215. Briefly describe histo differences between immature / mature dog prostates
a. Young
i. Acini not developed, no secretory function
ii. High N-C ratio
iii. First activity at 4 months
iv. Cuboidal / flat epithelium
b. Adult
i. Compound tubuloalveolar glands
ii. Alveolar structure
iii. 1. Simple dilatation (no compression of the adjacent acini)
2. Focal glandular ectasia (w compression of the adjacent prostatic parenchyma)
iv. Secretion present
215
216. What are consequences of spaying discussed around the world?
a. Tumors = TCC, OSA (Rottie spayed <1 year), heart tumors, HSA (Vizslas)
b. Diabetes mellitus cats
c. Hypothyroid dog
d. USMI (up to 20% bitch)
e. Obesity
f. UTI
216
217. With anesthesia for spay (young dogs), why at <5 mo age careful with drug dosing?
a. Cytochrome P450 enzyme not mature and lower plasma concentration
217
218. Which of epithelial ovarian tumor is the only one that is occasionally bilateral?
a. Papillary
218
219. Granulosa cell tumors make up __ % of ovarian tumors? Met rate?
a. 50% of ovarian tumors
b. 20% met rate
219
220. List differentials for ovarian tumors
a. Papillary adenoma / adenocarcinoma
b. Cystadenoma
c. Undifferentiated carcinoma
d. Granulosa cell tumor
e. Dysgerminomas
f. Teratomas
g. Teratocarcinomas
220
221. Overall prognosis with ovarian tumors
a. Single, no mets – good
b. Chemo may lengthen survival with metastatic disease
221
222. For feline ovarian tumors, what is most common?
a. Sex cord stromal; > 50% of granulosa cell tumors are malignant
222
223. With functional cysts – 2 types of them and have what hormonal effects?
a. If lined w granulosa cells
i. Secrete estrogen – prolonged proestrus
ii. If also progesterone – prolonged estrus
b. Luteinized cysts – only progesterone – prolonged Diestrus
223
224. How to diagnose functional cysts?
a. Vaginal cytology - >80% superficial cells on vaginal smear, increased serum estrogen
b. Hormones – progesterone >2 ng/mL; estrogen >20 pg/ml
224
225. List medical mgmt options for pyometra
a. PGF2a
b. Cloprostenol
c. Dopamine agonists, Cabergoline
d. GnRH antagonist (acyline)
e. Progesterone receptor antagonist (aglepristone)
f. Antibiotics
g. IVF etc
225
226. Mortality rate pyometra with surgery
a. 0-5%
226
227. What is associated with increased risk of mortality with pyometra?
a. Low central venous oxygen sat & higher base deficits
227
228. What are 2 types of cystic endometrial hyperplasia?
a. 1 – part of progesterone dependent disease complex + pyometra
b. 2 – induced by uterine irritation - deciduoma
228
229. What dog breeds usually seen with dystocia? Cats?
a. Dogs – chihuahua, pom, pugs, irish wolfhounds, great dane
i. Bostons, Bulldogs > 80%
b. Cats – Siamese, Persian, Devon rex
229
230. What is survival rate of C-section?
a. 99%
230
231. Does spay affect milk production?
a. Prolactin released centrally and independent of ovarian hormoes – no effect
231
232. How long does it take to involute uterus?
a. 12-15 weeks
231
233. What is most common uterine tumors? Dog vs cat and prognosis of each
a. Leiomyoma – 90% (dogs) – excellent
b. Adenocarcinoma – guarded
232
234. What is an anovulvar cleft?
a. Failure fusion between dorsal urogenital folds leave midline defect in perineal skin and separates anus and dorsal vulvar commissure
233
235. Treatment of anovulvar cleft?
a. Inverted V perineoplasty along mucocutaneous junction of perineal defect – dissect from skin and then appose
234
236. What % of patients with recessed vulva have urinary incontinence?
a. 56%
235
237. What is O satisfaction rate for episioplasty?
a. Excellent
236
238. What % dogs had neoplastic transformation with cryptorchidism?
a. 9-13.6%
237
239. What are concurrent diseases with increased rates with cryptorchid dogs?
a. Hip dysplasia, patellar luxation, defects penis / prepuce, umbilical hernia
238
240. What are concurrent diseases with increased rates with cryptorchid cats?
a. Patellar luxation, shortened / kinked tail, tetralogy of Fallot, tarsal deformities, microphthalmia, upper eyelid agenesis
239
241. Palpation to locate undescended testicle accurate in __% cats?
a. 48%
240
242. List 3 types of testicular tumors
a. Sertoli cell tumor
b. Seminoma
c. Interstitial cell tumor
241
243. List secondary changes seen with testicular tumors (if listed)
a. Sertoli – feminization syndrome
b. Interstitial cell tumor – increased testosterone – perineal hernia, perineal adenoma
242
244. What are components of feminization syndrome? What % Sertoli cell tumors have it?
a. Bilateral symmetric alopecia
b. Squamous metaplasia of prostate
c. Pendulous prepuce
d. Galactorrhea
e. Penile atrophy
f. Gynecomastia
243
245. List non surgical sterilization techniques
a. Testosterone and LH releasing hormone (LH-RH) agonist injection
b. Chlorhex digluconate
c. Gonadotropin-RH
d. Glycerol
e. Zine gluconate
244
246. List options / techniques for feline castration
a. Overhand
b. Figure of eight
c. Ligation
d. Square knot technique
245
247. What are treatment options for BPH? What is chosen tx?
a. Castration – choice
b. Antiandrogens (Delmadinone acetate)
c. Luteinizing Hormone Inhibitors (megestrol acetate)
d. Gonadotropin-Releasing Hormone agonists/ anologue (aka LH releasing hormone agonist)
e. 5 alpha reductase inhibitor (Finasteride) – decrease conversion of testosterone to dihydrotestosterone
f. Estrogens
246
248. Prognosis for BPH with tx?
a. With castration – excellent – CS resolve within a few days
247
249. What dog breeds more commonly get Ca oxalates? Cat breeds?
a. Dogs = Bichon Frise
b. Cats = Siamese
248
250. List tx options for kidney stones
a. Medical dissolution
b. Extracorporeal shock wave therapy (lithotripsy)
c. Nephrotomy
d. Pyelolithotomy
e. Endoscopic nephrolithotomy (intracorporeal lithotripsy)
f. Nephrectomy (most severe situation)
249
251. Most common renal tumor cats? Dogs?
a. Cats – lymphoma
b. Dogs – Renal cell carcinoma
250
252. What breeds get renal cystadenocarcinoma? What is met rate?
a. GSD – met rate 50%
251
253. What is met rate to abdominal cavity for feline renal tumor?
a. 36% met to abdominal cavity
252
254. List paraneoplastic syndromes of renal neoplasia
a. Hypercalcemia
b. Hypoglycemia
c. Leukocytosis
d. Peripheral neuropathy
e. Rarely – hypertrophic osteopathy
253
255. List contraindications of renal biopsy
a. Uncontrolled coagulopathy or hypertension
b. Large or multiple renal cysts or abscesses
c. Extensive pyelonephritis
d. Ureteral obstruction
e. Severe hydronephrosis
f. Interference or obstruction of site by other organs / masses
254
256. List methods of kidney biopsies
a. Percutaneous biopsy
b. US-guided biopsy
c. Keyhole biopsy
d. Laparoscopic biopsy
e. Wedge or incisional biopsy
255
257. Major complication rate of renal biopsies? Most common?
a. 8.9%, severe hemorrhage
256
258. What are 2 nephrotomy options
a. Bisectional nephrotomy (incise pole to pole)
b. Intersegmental (bluntly separate)
257
259. With partial nephrectomy, what can be done to augment if apposition not reasonable?
a. Preserve capsule to suture over
b. Tack omentum to exposed surface
c. Wrap kidney in absorbable mesh
d. Hemostatic sealants
258
260. Why is it recommended to remove ureter with kidney?
a. Concern for ureteral reflux or possible UTI
259
261. What are examples of nephrostomy tubes?
a. Swan-Ganz, Dawson-Mueller catheter or red rubber
260
262. Explain the pathophys of ureteral obstruction
a. First pressure increase, peak 5 hours, lessen (but still inc) over 12-24 hours
b. Renal blood flow decreases to 40% of normal over first 24 hours
c. Decrease to 20% of normal by 2 weeks
d. Increase pressures / decreased BF – decreased GFR - leads to increased GFR in contralateral kidney
e. Inflammatory cells and fibroblasts come in – fibrosis etc
261
263. What is complication rate of nephrostomy tube in cats?
a. 50%
262
264. Post-op uroabdomen more common with use of __% nephrostomy tubes then without __%?
a. Indwelling nephrostomy tubes (24%) then without (12%)
263
265. For ureter R&A, what do you need to remove?
a. Clear periureteral fat
264
266. What are methods to decrease tension? For ureteral reimplantation
a. Shift kidney caudally (renal descensus)
b. Pexying apex bladder to caudal pole of kidney or iliopsoas
c. Ureteral R&A
265
267. What are listed risk factors associated with survival with kidney transplants?
a. Age
b. Severity of disease
c. Blood pressure
d. Weight
266
268. List drug options for immunosuppression for feline transplants
a. Cyclosporine
b. Prednisolone
c. Azathioprine
d. Tacrolimus
e. Mycophenolate
f. Sirolimus
g. Leflunomide
h. Abatacept / belatacept
i. +/- ketoconazole
267
269. What % of nephrotomy patients get decreased GFR long term?
a. 10-20% (variable literature)
268
270. What is % persistent ureteral obstruction with ureteral reimplantation vs ureterotomy?
a. Ureteral reimplantation 11%
b. Ureterotomy 3%
269
271. Ureteral R&A – takes __ weeks to get coordinated peristalsis return?
a. 3-4 weeks
270
272. List tx options for urethral duplication
a. Open sx removal
b. Cyanoacrylate
c. Coil embolization
d. (of accessory urethra)
271
273. For palliative care of urethra for TCC, what is the preferred stents now?
a. Self-expanding metallic stents
272
274. With stents, what is rate of successful resolution UTO? MST?
a. 98%, MST 251 days
273
275. What % get urinary incontinence?
a. 26%
274
276. What are most common cause of dog vs cat urethral trauma?
a. Cat – urethral catheter
b. Dog - HBC
275
277. With urethral strictures, what location should you NOT do urethrostomy for treatment?
a. Proximal intrapelvic
276
278. List tx options for urethral stricture
a. Urethrostomy
b. R&A
c. Balloon dilatation
d. Stent placement
e. Urethral replacement (ileum, aortic stent graft)
f. Stem cells + synthetic biodegradable scaffold
g. Oral mucosal grafts
