Term
| What do we check/fix before sx of kidneys and/or ureter? |
|
Definition
-collect minimum database
-correct abnormalities: fluids, blood pdt
-ensure adequate urine pdn
-avoid NSAIDs in renal patients |
|
|
Term
| What are our considerations of abx therapy? |
|
Definition
-good conc in urine: Penicillins, Cephalosprins
-cover g-: Enrofloxacin
-avoid nephrotoxic drugs: aminoglycosides, tetracyclines, sulfonamides |
|
|
Term
| What type of suture do we use? |
|
Definition
| -monofilament, absorbable |
|
|
Term
|
Definition
-suturres placed full thickness
-simple interrupted or continuous |
|
|
Term
| Describe our suture technique. |
|
Definition
-avoid occlusion of lumen
-ensure patency of urine flow
-be aware of structure |
|
|
Term
| Describe the healing of the urinary system. |
|
Definition
| -extremely well, when compared to GI tract |
|
|
Term
| What are the important anatomic notes of the kidneys? |
|
Definition
-troperitoneal space: lots of fat surrounding them
-hilus: multiple renal aa possible, medially located
-right kidney sits higher than the left
-left kidney is more mobile than the right |
|
|
Term
| What are the basic principles of kidney biopsy? |
|
Definition
-cortical sample preferred: go in parallel w/ cortex
-avoid medullary tissue: little diagnostic importance, risk of seirous hemorrhage |
|
|
Term
| What are the three major techniques of kidney biopsy? |
|
Definition
-open surgical (GOLD STANDARD): best visualization, beter control of hemorrhage
-U/S-guided: greater risk of hemorrhage, serial monitoring for fluid
-laparoscopic-guided: great visualization, minimal approach surgically |
|
|
Term
| What are the indications of nephrotomy? |
|
Definition
| -explore the pelvis: hematuria, neoplasia, huge stone |
|
|
Term
| What are some considerations of nephrotomy? |
|
Definition
| -expect a 20-50% reduction in GFR from an incised kidney (wlll generally return to normal, can result to normal, can result in temporary renal failure if other kidney is compromised) |
|
|
Term
| Vaguely describe the surgical technique of a nephrotomy. |
|
Definition
-longitudinal incision into boy
-hemostasisi is very important
-suture capsule w/ horizontal mattress |
|
|
Term
| What are some possible complications w/ nephrotomy? |
|
Definition
-renal function can be temproarily diminished
-urine leakage
-stage procedures if indicated bilaterally |
|
|
Term
| What are some indications for nephrectomy as a salvage procedure? |
|
Definition
-neoplasia
-severe trauma: blunt force trauma, gushot
-pyelonephritis
-hydronephrosis
-ureteral abnormality/trauma |
|
|
Term
| Vaguely describe nephrectomy surgical techniques. |
|
Definition
-free kidney from retroperitoneal attachments
-dissect a & v from hilus: double ligate vessels
-dissect ureter from the retroperitoneal attachments: ligate/transect close to bladder |
|
|
Term
| What are our three major surgeries done on ureters? |
|
Definition
-subcutaneous ureteral bypass
-neoureterostomy
-ureteroneocystostomy |
|
|
Term
| What are the important antaomic remarks that can be made about the ureters. |
|
Definition
=exit at hilus of kidney
-course caudally
-enter bladder at trigone |
|
|
Term
| What are our major differentials for partial ureteral obstruction? |
|
Definition
|
|
Term
| What are our major differentials for complete ureteral obstruction? |
|
Definition
-stone
-trauma: ligated ureter, transected/torn ureter |
|
|
Term
| Describe the clinical presentation of a ureteral obstruction? |
|
Definition
-lethargic, anorexc
-able to urinate unless bilaterally obstructed
-hydronephrosis: everything proximal to the problem dilates
-azotemia: post-renal
+/- infeciton |
|
|
Term
| How do we diagnose ureteral obstruction? |
|
Definition
-abdominal rads +/- contrast
-U/S |
|
|
Term
| What are th ecommon indications for a ureteral bypass? |
|
Definition
-bypass tramatized/obstructed ureter
-can be permanent or temporary |
|
|
Term
| What are our two location options for surgical catheter placement? |
|
Definition
-into renal pelvis
-into urinary bladder (apex) |
|
|
Term
| What is the most common location for outflow point of ectopic ureter? |
|
Definition
|
|
Term
| Describe the signalment of ectopic ureters. |
|
Definition
-85% females
-70-80% unilateral |
|
|
Term
| Ectopic ureter must be considered in any dog w/ ______. |
|
Definition
|
|
Term
| What is the typical signalment of ectopic ureter? |
|
Definition
-Siberian Husky
-Goldens
-Labrador
-Newfoundland
-Mini Poodle
-Bulldog |
|
|
Term
| What are the typical C/S of ectopic ureters? |
|
Definition
+/-INCONTINENCE
+/- urine scald
+/- UTI (recurring) |
|
|
Term
| What is the gold standard diagnostic of ectopic ureter? |
|
Definition
|
|
Term
| What are the two options of ectopic ureters? |
|
Definition
-intramural: ureter enters bladder & tunnels submucosally until exit in urethra/vagina
-extramural: ureter completely bypasses the bladder |
|
|
Term
| How do we surgically fix an intramural ectopic ureter? |
|
Definition
-neoureterostomy: create a new stoma
-cytoscopic laser ablation |
|
|
Term
| How do we surgically fix an extramural ectopic ureter? |
|
Definition
| -ureteroneocystostomy (reimplantation) |
|
|
Term
| Incontinence may persist after sx on ectopic ureter. Why? |
|
Definition
-incomplete sx repair
-pelvic bladder location
-urethral sphincter incompetence
-tension present on ureter repair
-more likely w/ bilateral |
|
|
Term
| How do fix an intramural ectopic ureter? |
|
Definition
-neoureterostomy
-cystoscopic laser ablation |
|
|
Term
| What is a neoureterostomy? |
|
Definition
| -create a new hole from inside the ureter into the bladder |
|
|
Term
| How do you fix an extramural ectopic ureter? |
|
Definition
|
|
Term
| What is an ureteroneocystostomy? |
|
Definition
| -transect distal ureter & reimplant ureter into bladder |
|
|
Term
| Incontinence may persist after surgery to fix an ectopic ureter. What are some examples of why that happens? |
|
Definition
-incomplete surgical repair
-pelvic bladder location (ex: pelvic bladder)
-urethral sphincter incompetence
-tension present on ureter repair
-more likely w/ bilateral |
|
|
Term
| How common are primary renal tumors? |
|
Definition
|
|
Term
| Describe the incidence of primary renal neoplasia. |
|
Definition
-85% are malignant
-met to chest commonly |
|
|
Term
| What is the most common type of primary renal tumors? |
|
Definition
|
|
Term
| What do we have to ensure before ureteronephrectomy? |
|
Definition
| -make sure renal function is adequate (contralateral kidney) |
|
|
Term
|
Definition
| -developmental anomaly in ales: urethral opening is ventral and caudal to normal opening |
|
|
Term
|
Definition
| -inability of penis to protrude from the prepuce/sheath: congenital & trauma |
|
|
Term
| What is the typical hx of phimosis? |
|
Definition
-urine pooling
-chronic, purulent preputial discharge |
|
|
Term
| In general, how do we surgically correct phimosis? |
|
Definition
-enlarge preputial opening
-create a new mucocutaneous junction |
|
|
Term
| What is the acute presentation of paraphimosis? |
|
Definition
| -can be medically managed: reduce: something like sugar w/ uterine prolapse & lubrication |
|
|
Term
| What is the chronic presentation of paraphimosis? |
|
Definition
| -surgical intervention warranted |
|
|
Term
| What are our surgical options for fixing a chronic paraphimosis? |
|
Definition
-preputial reconstruction: make prepuce longer
-prepultiotomy
-phallopexy
-penile amputation
-castration |
|
|
Term
| What is a preputioplasty? |
|
Definition
| -suture skin forward to pull prepuce forwad |
|
|
Term
|
Definition
| -make hole in prepuce smaller |
|
|
Term
|
Definition
| -tacking penis to inside of sheath |
|
|
Term
| What are the requirements of a penile amputation? |
|
Definition
-scrotal urethrostomy
-scrotal ablation |
|
|
Term
| What are the indications for a penile amputation? |
|
Definition
-neoplasia
-trauma
-congenital anomalies |
|
|
Term
| Describe the important anatomic features of the bladder. |
|
Definition
-bladder sits in caudal abdomen: genital organs are dorsal to the bladder
-divided into apex, body, neck |
|
|
Term
| What are the ligamentous attachments of the bladder? |
|
Definition
-ventral median ligament: attaches to linea, pubic symphysis
-lateral ligamnets: attaches to pelvic walls, contain fat/ureter/umbilical a |
|
|
Term
| What is the trigone of the bladder? |
|
Definition
-dorsal bladder wall
-b/n ureteral openings & urethra
-very important b/c cannot be reconstructed |
|
|
Term
| What is the typical presentation of a bladder dz case? |
|
Definition
-hematuria
-dysuria
-pollakiuria
-lethargic
-dec appetite
-ADR |
|
|
Term
| Describe the wound healing that occurs in the bladder. |
|
Definition
-bladder regains 100% of normal strength in 14-21d
-complete re-epithelialization occurs w/in 30d |
|
|
Term
| What are the major anatomic considerations for bladder surgery? |
|
Definition
-avoid incisions over/near the trigone b/c cannot be reconstructed
>50% of the bladder cna be removed |
|
|
Term
| True or False: Urine is sterile unless infection is present. Thus, it is of no concern if urine leaks into the abdomen. |
|
Definition
-FALSE
-it is sterile but will cause chemical peritonitis
-if infection is present then it would cause a septic peritonitis |
|
|
Term
| What is a cystotomy? What are the common indications for it? |
|
Definition
-incision into the bladder
-indications, urinary calculi, neoplasia, polyp removal, repair of ectopic ureter, cystostomy tube, cystopexy |
|
|
Term
| Describe the surgical technique for cystotomy. |
|
Definition
-caudal abdominal approach: umbilicus to pubis
-exteriorize & isolate the bladder
-stay suture placement
-have suction ready
-incision location: ventral |
|
|
Term
| What are the two types of stay sutures used for a cystotomy? |
|
Definition
-1 at apex & 1 body on midline
-1 apex & 2 in body: off midline |
|
|
Term
| Why do we make the bladder incision on the ventral side of the bladder for a cystotomy? |
|
Definition
-traditionally: dorsal
-avoids blood supply
-avoids trigone (b/c of the ureters) |
|
|
Term
| Why do we use suction on the urine from the bladder? |
|
Definition
-minimal leakage
-urine is often infected w/ stones/ectopic ureter |
|
|
Term
| What do we add to our urine cultures during a cystotomy if we need to? |
|
Definition
-section of bladder wall
-stone |
|
|
Term
| Why do we lavage the bladder during a cystotomy? |
|
Definition
-removes remaining debris
-removes blood |
|
|
Term
| How do we close the bladder during a cystotomy? |
|
Definition
-simple continuous or interrupted
-full thickness: have to grab the holding layer
-monofilament, absorbable suture |
|
|
Term
| Why would we use interrupted suture pattern to close the bladder? |
|
Definition
|
|
Term
| What must we do after finishing the closure of the bladder after a cystotomy? |
|
Definition
|
|
Term
| How do we remove stay sutures from a cystotomy site? |
|
Definition
| -cut one side of suture close to the bladder |
|
|
Term
| What is a partial cystectomy? |
|
Definition
| -removal of part of the bladder |
|
|
Term
| What are the indications for a aprtial cystectomy? |
|
Definition
-neoplasia
-necrotic/traumatized bladder |
|
|
Term
| On which locations of te bladder must a lesion be to allow a partial cystectomy? |
|
Definition
-apex/body
-NEVER EVER THE TRIGONE |
|
|
Term
| How does a partial cystectomy alter the function of the bladder? |
|
Definition
| -the function remains the same but it is way smaller |
|
|
Term
|
Definition
| -bladder is sutured to lateral body wall |
|
|
Term
| What are the indications for a cystopexy? |
|
Definition
-perineal hernia w/ bladder entrapment
-augment ureteral anastomosis |
|
|
Term
| Briefly describe the surgical technique of a cystopexy. |
|
Definition
-open approach
-laparoscopic/lap-assisted
-tube cystostomy |
|
|
Term
| What are the two types of tube cystostomy? |
|
Definition
|
|
Term
| When would you use a temporary tube cystostomy? |
|
Definition
-if a patient is unstable: obstruction from calculi, urethral trauma
-diversion of urine until definitive procedure |
|
|
Term
| When are some examples of when a permanent tube ystostomy would be necessary? |
|
Definition
-neurologic: bladder atonia/ dysenergia
-urethral obstruction: neoplasia |
|
|
Term
| Vaguely describe the surgical technique behind a tube cystostomy. |
|
Definition
-small ventral midline incision w/ a purse-string suture
-stab incision into bladder
-place tube into body wall: separate stab inciion
-insert tube/ tighten purse-string
-perform a cystopexy
-secure tube to body wall |
|
|
Term
| What are our surgical options for urinary calculi? |
|
Definition
| -cystotomy +/- urohydropulsion |
|
|
Term
| Briefly describe a cystotomy for urinary calculi. |
|
Definition
-remove stones from lumen
-lavage bladder thoroughly: makes sure everything is cleaned up before the patient wakes up
-urinary catherterization: normograde, retrograde (males only)
-close bladder |
|
|
Term
| What are some common causes of a uroabdomen? |
|
Definition
-blunt trauma
-gunshot/penetrating injury
-dehiscence from recent surgery
-necrotic neoplastic lesion |
|
|
Term
| What are some consequences of a uroabdomen? |
|
Definition
-electrolyte imbalances: hyperkalemia
-dehydration
=hypovolemia => shock
-uremia
-death |
|
|
Term
| How do we diagnose a uroabdomen? |
|
Definition
-CVC/chem: infection, azotemia
-abdominal rads: loss of serosal detail
-abdominocentesis: creatinine way higher than blood creatinine
-contrast cystourethrogram: iodide contrast medium injected into urethra |
|
|
Term
| Can we use BUN from abdominocentesis to diagnose a uroabdomen? |
|
Definition
| -no b/c it is a small molucle than creatinine thus it is absorbed back into body more quickly & less consistent |
|
|
Term
| What is the most common form of bladder neoplasia? What are some other types? |
|
Definition
-TCC
-others: SCC, adenocarcinoma, hemangiosarcoma, fibrosarcoma, leiomyosarcoma, benign tumors |
|
|
