Urogenital surgery (Yr4) Flashcards
what are the possible clinical signs of prostatic disease?
anorexia, lethargy, weight loss, pyrexia
urinary… dysuria, haematuria, urine retention
defaecatory… tenesmus, ribbon-like faeces, constipation
stiffness and straddling gait
what are the possible disease effecting the prostate?
benign prostatic hyperplasia
prostatitis
abscessation
cysts
neoplasia
what is the signalment of benign prostatic hyperplasia?
older middle aged entire dogs
what is found when rectalling dogs with benign prostatic hyperplasia?
symmetrically enlarged pain-free prostate with a homogenous consistency
how is benign prostatic hyperplasia treated?
castration (caused by androgens)
anti-androgen drugs but not as effective as castration
what causes prostatitis/abscessation?
ascending infection from urethra (often proceeding benign prostatic hyperplasia)
what is the typical organism that causes prostatitis/abscessation?
E. coli
what is found on rectal palpation of patients with prostatitis/abscessation?
asymmetrically enlarged painful prostate (pain on abdominal palpation also)
how is prostatitis/abscessation treated?
antimicrobials for 4-6 weeks along with castration
can also drain but they often reoccur and can burst to cause a peritonitis
what is the difference between a prostatic and paraprostatic cyst?
paraprostatic - outside of prostate capsule and don’t communicate but are attached to the prostate
prostatic - within the capsule of the prostate
what is found on rectal of prostatic cysts?
prostate not palpable
how are prostatic cysts treated?
US guided drainage or surgical resection
castration
what is the most common prostatic neoplasia seen in dogs?
adenocarcinomas
what is found on rectal palpation of prostatic neoplasias?
pain and enlarged prostate
what palliative care is available for prostatic neoplasias?
cystotomy or urethral stenting
analgesia
radiation therapy
what are the three types of testicular neoplasia?
interstitial cell (leydig) tumour
Sertoli cell tumour
seminoma
what is a common clinical sign of sertoli cell tumours?
feminisation syndrome (penile atrophy, attraction to males, gynecomastia, galactorrhea, oestrogen can cause myelotoxicity)
what is phimosis?
inability to protrude penis from prepuce
what causes phimosis?
narrowing of preputial opening from infection or congenital malformation
what is paraphimosis?
inability to retract penis into the prepuce
what are the surgical treatment options for paraphimosis?
enlargement of preputial opening
phallopexy
penile amputation
what are the contraindication of neutering before the first season?
juvenile vaginitis
juvenile urethral sphincter mechanism incompetence
what is the pathogenesis of how pyometra forms?
during the luteal phase progesterone stimulates growth/activity of the endometrial glands along with suppressing the immune system which can lead to mucous/blood collecting which can turn septic
what is the main pathogen that causes pyometra?
E. coli
what are some clinical signs of pyometra?
PUPD, lethargy, inappetence, vomiting, pyrexia, dehydration, pain , vaginal discharge
(can lead to SIRS)
what would be a good antibiotic choice for a pyometra?
cefuroxime or amoxicillin/clavulanic acid
what is the preferred treatment for a pyometra?
ovariohysterectomy
what is needed for a uterine stump pyometra to form?
a progesterone source (ovarian remnant)
what is the major clinical signs of ovarian remnant syndrome?
recurrent oestrus signs (attraction to males, enlarged vulva…)
how can ovarian remnant syndrome be diagnosed?
history and vaginal cytology
hormone assays (progesterone, anti-mullerian hormone)
what causes a uterine stump granuloma?
poor aseptic technique
using non-absorbable suture for ligatures
excessive uterine body remaining
when does vaginal hyperplasia occur?
during proestrus/oestrus under the influence of oestrogen, leading to oedematous enlargement of the vagina
what can vaginal hyperplasia lead to?
prolapse
what is the recommended treatment for vaginal hyperplasia (prolapse)?
lubricate and prevent self-trauma
resect if tissue is non-viable
spaying is recommended
what us episioplasty?
reconstructive surgery to remove excess skin folds around the vulva which might be causing problems such as peri-vulvar dermatitis
where can ovarian neoplasias arise from?
germ cells (teratoma, teratocarcinoma)
epithelial (adenoma, adenocarcinoma)
sex cord stromal (granulosa cell tumour)
what are the most common uterine neoplasias?
dogs… leiomyomas
cats… adenocarcinomas (rare)
what is the prognosis for inflammatory carcinomas?
poor (highly metastatic and rapidly progressive)
what is the innervation for the filling/storage phase of the bladder?
mainly sympathetic (via hypogastric nerve)…
beta-adrenoreceptors in detrusor muscle (relaxation)
alpha-adrenoreceptors in urethral smooth muscle and trigone (contract)
what is the innervation for the emptying phase of the bladder?
parasympathetic (via pelvic nerve)…
detruser reflex is when the stretch receptors of the bladder wall are stimulated causing contraction
what allows you to have voluntary control over the detrusor reflex?
cerbral cortex
what are the typical findings of a filling phase incontinence?
patients urinate/empty bladder normally
dribble urine between urinations
reduced bladder capacity
what are some differentials for filling phase bladder incontinence?
ectopic ureter
reduced pressure at the bladder neck
involuntary contractions (infection, drugs, neoplasia, calculi)
what are the typical abnormalities of incontinence associated with the emptying phase?
distended bladder
no normal urination
often dribble urine
what are some differentials for incontinence relating to the emptying phase?
partial/complete urethral obstruction
chronic bladder distention (trauma…)
dyssynergia (poor muscle coordination)
what is the most common form of incontinence in the bitch?
urethral sphincter mechanism incompetence
what are the clinical signs of urethral sphincter mechanism incompetence?
intermittent involuntary passage of urine usually whilst relaxed
don’t dribble urine and can urinate normally
what are some causes of urethral sphincter mechanism incompetence?
low urethral tone
hormonal (spaying prior to first season)
obesity
intrapelvic bladder
what breeds typically get urethral sphincter mechanism incompetence?
doberman, boxers, Irish setters
how can urethral sphincter mechanism incompetence be treated medically?
increase muscle tone (phenylpropanolamine)
estriol
reduce contributing factors (weight loss, UTI…)
what is the difference between an intramural and extramural ectopic ureter?
intramural - tunnels through the bladder to connect to urethra/rectum
extramural - completely bypasses the bladder
what is a possible consequence of prolonged ureteric obstruction in cats?
hydronephrosis
what stage of the oestrus cycle should you neuter a bitch?
anoestrus
when should early neutering (before the first season) be avoided?
if congenital USMI or juvenile vaginitis is present (these need hormones to resolve)
what is the difference between open and closed castration?
open incises through the vaginal tunic
