Urogenital Surgery Flashcards by Simon Thackray

How large should a kidney be on xray?

Cat 2-2.5x L2

Dog 2.5-3.5x L2

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How is a renal lymphoma treated?

chemotherapy

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How is unilateral renal neoplasia treated?

Ureteronephrectomy

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What are the 2 most common embryological abnormalities of the bladder?

Patent urachus

Vesicourachal diverticulum

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What suture material should be used to close the bladder?

Monofilament absorbable i.e. PDS

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what are the 3 indications for a tube cystotomy?

Decompression of atonic bladder
Urethral transection
Bladder neck/urethral tumour

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How should a bladder rupture be treated?

May heal on own.

If not - debride and suture. Can omentalise.

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What proportion of the bladder may be removed surgically?

75%

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Where are the 3 places that males are predisposed to urethral Dz?

Neck of bladder - prostate
Pelvic - #s can injure
Penile - limited distension capacity

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What are the 4 predisposing factors for urethritis?

Trauma
Catheter
Urolith
Neoplasia

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How is a urethral prolapse treated in the male?

Purse string suture.
Can resect tissue.
CASTRATE, sedate, buster collar.

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What are the signs of urethral blockage?

Dysuria
Anuria
Haematuria
Dripping urine
Abdominal pain
Uraemia

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Why is IVFT used in urethral obstruction?

Correct acid/base imbalance and electrolyte disturbances

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How should a bladder be emptied in a blocked urethra?

Cystocentesis

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What surgical procedure is performed if retro-hydropulsion is unsuccessful at removing a urethral calculi?

Urethrotomy

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Where is the preferred site of urethrostomy on male neutered animals?

Scrotal

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When is a pre-pubic urethrostomy performed?

insufficient urethral length for pelvic urethrostomy

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What is the treatment for urethral neoplasia?

Sx unlikely - can resect parts.
Permanent tube cystotomy/stent.
Palliate - poor px.

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When can kittens be neutered from? (BSAVA)

4m+

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What manouvre can be used on the RHS to locate the ovary?

Duodenal

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What manouvre can be used on the LHS to locate the ovary?

Colonic

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Which 2 ligatures should be used in the cervix during an OVH?

Transfixing + encircling

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Which pattern should be used in the abdo wall following a bitch spay?

Simple continuous

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What are your 3 options for skin suture pattern following an OVH?

Intradermal

Interrupted/cruciate mattress

Staples

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What are your 2 landmarks for a feline flank spay?

External angle of ilium | Hip

Which analgesia should pets be given after neutering?

Local! Methadone (premed) NSAID post (+paracetamol in dogs) 3-5days!!

What is the strength holding layer of the abdomen?

Fascia of rectus abdominus

Which drug helps 90% of dogs with post-neutering USMI?

Phenylpropanolamine - increases muscle tone

What is the second line treatment for post-neutering USMI?

Ephedrine 3rd: estriol

If medical treatments don't solve post-op USMI - what are the surgical options? (3)

Colposuspension Hydraulic urethral occluder Urethral submucosal collagen injections

Which 2 nerves are responsible for bladder filling and storage?

Pudendal (somatic) and Hypogastric (SYMP)

Which nerve is responsible for bladder emptying?

Pelvic (PARA)

What are the signs of a filling defect in the bladder?

Urinary normally Dribble urine Reduced bladder capacity

What may cause bladder filling abnormalities?

Ectopic ureters Reduced pressure at bladder neck Involuntary contractions (infection, calculi, neoplasia)

What are the signs of bladder emptying abnormalities?

Distended bladder No normal urination Constant urine dribbling

What may cause a bladder emptying abnormality?

Urethral obstruction Chronic distension Dyssynergia

What is the most common cause of incontinence in the bitch?

USMI

What are the signs of USMI?

Incontinence when relaxed | Otherwise urinate normally

What is the cause of USMI?

Low urethral tone Obesity Hormonal influence possible (speyed befroe 1st season)

How is congenital USMI treated?

1st season resolves it in 50% of cases If not: Inc muscle tone and reduce contributing factors

Apart from phenylpropanolamine, which drugs can be given to male dogs with USMI?

Oestrogen based drugs

Which breeds of dog are predisposed to ectopic ureters?

Golden Retriever Lab Skye terrier Husky

Where do ectopic ureters commonly empty?

Urethra, vagina or rectum

What is a common 2e condition for ectopic ureters?

UTIs

In a patient with an ectopic ureter you perform an ExLap and find Unilateral ectopia, severe hydronephrosis. Best surgical option?

Ureteronephrectomy

In a patient with an ectopic ureter you perform an ExLap and find extramural ectopia. Best surgical option?

Ureteral transection and re-implantation

In a patient with an ectopic ureter you perform an ExLap and find intramural ectopia. Best surgical option?

Intravesical repair

What is the most common cause of incontinence in the Cat?

Tail pull injury or sacral # (neurogenic) Can also have juvenile or iatrogenic

How long can a ureteral obstruction exist before the damage it causes is irreversible?

What can be done for a traumatic avulsion of the ureter at the bladder?

re-implantation

What are the 2 CIs for OVH prior to 1st season? (bitch)

Juvenile Vaginitis | Juvenile USMI

What are the 2 major advantages to OVH prior to 1st season?

BVs smaller | Reduced mammary neoplasia

When should an elective OVH take place?

>12w after oestrus or >6-8w PP (>3w post-weaning)

Which hormone drives cystic endometrial hyperplasia?

Progesterone - growth of glands, reduced action of myometrium, allows bacteria to thrive

What are the signs of pyometra?

``` V+ PUPD Inappetance Dehydration Palpably enlarged uterus ```

What are the 3 mainstays of OVH treatment?

IVFT ABs OVH

How can you confirm ovarian remnant syndrome?

Stimulation tests

How can vaginal hyperplasia be treated?

WILL regress after follicular phase In meantime: collar, lubrication and if prolapsed - purse string

Where is a canine episiostomy cut?

12 o clock

What is the major indication for an episioplasty?

Excess skin folds cause peri-vulval dermatitis

What are the 3 possible clinical signs with ovarian neoplasia?

Malignant effusion Abdo mass symptoms Hormonal Dysfunction

What investigations can be done for an ovarian tumour/

``` Palpate! H/BC Rx US Abdominocentesis ExLap ```

90% of canine uterine tumour are which type of neoplasia?

Leiomyoma

What is the Px for Leiomyomas?

Good if no mets - remove surgically

The majority of feline uterine tumour are which type of neoplasia?

Adenocarcinomas (Px guarded)

What is the most common tumour in the bitch?

Mammary Carcinoma

Which mammary glands are most commonly affected by neoplasia in the bitch?

Caudal mammary glands

Which neoplastic Dz is hard to differentiate from mastitis due to its poor demarcation, ulceration and reddening?

Inflammatory carcinoma - poor Px

What is the difference in malignancy between feline and canine mammary tumours?

Dog: 30-50% Cat: 90%

Which mammary glands are most commonly affected by neoplasia in the queen?

cranial mammary glands

What are the clinical signs of prostatic Dz?

Urinary (dysuria, blood dripping) Defaecatory (tenesmus, flat faeces, constipation) HL pain/stiffness

How is prostatic Dz diagnosed?

``` Palpation Urinalysis Rx Prostatic massage/biopsy Abdo US ```

What are the 5 major Ddz of prostatic Dz?

``` BPH Prostatitis Prostatic Abscessation Prostatic cysts Prostatic Neoplasia ```

How is BPH treated?

Castration +/- anti-androgens

How does BPH present?

Symmetrically enlarged and non-painful

How does prostatitis/Prostatic abscess present?

Asymmetrical, painful enlargement Dog febrile Stiff HL Abdo pain

How are prostatic abscesses treated?

ExpCoel + drainage of abscess 4-6w course AB to follow

How are prostatic cytsts treated?

Excision (if paraprostatic) Drainage and omentalisation US drainage Castration

What is the most common prostatic neoplasia in dogs?

Adenocarcinoma

What % of prostatic neoplasia has metastasised at time of diagnosis?

80%

How do prostatic adenocarinomas metastasise?

VIa LN to lungs, skeleton (lumbar) May directly extend into colon/bladder

How is prostatic adenocarcinoma diganosed?

Rx: wispy lumbar vertebrae, mineralised prostare US Biopsy (catheter/FNA)

How is prostatic neoplasia tretaeD?

Palliate - analgesia and stool softeners, urethral stent

When is scrotal ablation indicated?

Scrotal Dz

What is the reccomended Tx for cryptorchidism?

Bilateral castration

What are the 3 types of testicular tumour in the dog?

Sertoli Cell tumour Seminoma Interstitial Cell tumour

What are the 2 reasons that treatment of sertoli cell tumours is important?

Produce oestrogen and metastasise readily

What are the clinical signs of a sertoli cell tumour?

``` Abdo distention Feminisation Haem abnormalities (myelotoxicity) Prostatic enlargement ```

Which testicular tumours do NOT metastasise?

Interstitial cell tumour

How are testicular tumours treated?

``` Castrate Blood Transfusion (severe anaemia and TCP) ```

What is phimosis usually 2e to?

Trauma Neoplasia Infection

How is phimosis treated?

ABs if infected Urinary diversion (catheter) Preputial lavage Resolve stricture if present

How is paraphimosis treated?

Identify cause Relieve constriction Reduce oedema: massage, diuretic, CS Flush prepuce with saline and lube

How are fractures of the os penis treated?

Urethral catheter as stent Stabilise with plate Can manage conservatively!