What nerve(s) supply the bladder?
Sympathetic: Hypogastic Ns
Parasympathetic: Pelvic N
Somatic: Pudendal N (to sphincter and urethra)
What is the vascular supply of the bladder?
Main supply: Caudal vesicular artery (from vaginal/prostatic artery)
Cranial vesicular artery (from umbilical artery)
What are the types of urachal abnormalities? (2 common, 2 rare) Which is the most common?
Vesicouracheal diverticulum (most common)
Urachal cyst- rare
Urachal sinus- rare
How is a persistent urachus diagnosed? How is it managed?
Dx: Place contrast in umbilicus
Tx: Surgical removal of urachal tube
How is a vesicouracheal diverticulum diagnosed? How is it managed? Why is it important to treat it?
Dx: Positive contrast cystography
Tx: Partial cystectomny and diverticulectomy
Predisposes to uroliths and UTI due to urine pooling
What is the most common cause of bladder rupture? What are some other causes?
Most common: Trauma
How could you diagnose a ruptured bladder (4 ways)?
Plain radiographs -Look for abdominal fluid, absence of bladder, decreased serosal detail
US - Look for free fluid, concurrent injuries (Can be used to guide abdominocentesis and determine source of injury)
Positive contrast urethrocystogram - MOST RELIABLE
Abdominocentesis- Urea in fluid = serum urea, CRE in fluid > serum CRE, high K in fluid
What are the indications of a tube cystotomy?
To stabilize a patient with LUT obstruction that cannot be catheterized
Bladder/urethral trauma or surgery
Long term for neurologic bladders (usually use a low profile tube cystotomy)
What suture do you place prior to making a stab incision for a tube cystotomy? Where do you make the incision? Which catheters can you use and which one does Betance prefer?
Purse-string suture Incision made between the purse strings
Foley (preferred) and Mushroom tip
What are the complications for a tube cytotomy? Are these common?
-Inadvertent removal (that's why always use e-collar and abdominal bandage)
-Pet chewing on tube
-Breakage of mushroom tip
-Fistula formation after removal
-Urine leakage around the tube (usually caused by purse-strings being too lose)
High complication rate
What are the indications for a cystopexy? What are you "pexy"-ing (what to what)? How many lines of sutures do you make?
-Urinary incontinence associated with pelvic bladder
Suture bladder wall to abdominal wall
2 lines of sutures (use 3.0 monofilament absorbable or non-absorbable)
What are the most common types of cystic calculi?
Calcium oxalate (most common)
How are cystic calculi diagnosed and what clinical signs are associated with them?
Dx: Plain radiographs, Pneumocystography, Double contrast cystography, US
CS: large thick bladder +/- palpable calculi, UTI common, other LUTD signs
What are the non-surgical management options for cystic calculi? Mention advantages and disadvantages for each.
(+) Way to remove stones without surgery
(-) Can irritate/traumatize bladder/urethra, may take several attempts, only for small stones, could cause urethral obstruction
(+) Way to remove stones without surgery
(-) Urethral irritation, may need to repeat often if there are multiple stones, only for small stones, not for smaller patients
(+) Way to remove stones without surgery, can make the stones smaller so that other non-surgical removal could be done
(-) May not be available
(+) Non-surgical, easily implemented
(-) Only works for certain stones, better as prevention not treatment
When is surgery indicated for cystic calculi? How is the procedure performed and how would you close (include suture options, patterns and closure techniques)?
-If no other medical/non-surgical options worked
Most common surgery = CYSTOTOMY
Either dorsal approach or ventral (better because can visualize ureteral orifices)
1. Caudoventral midline approach
2. Moisten lap sponges
3. Empty bladder
(3a.) (Drape prepuce)
4. Transect ventral ligament (dont touch lateral ligaments)
5. Place stay sutures on lateral aspects and apex (for handling bladder)
6. Stab incision at apex
7. Extend incision with scissors
8. Evert walls and inspect
9. Remove calculi
10. Pass urethral catheter, flush to ensure patency
(Submit urine, stones, and mucosal tissue for C/S)
11. Close (see below)
12. Leak test bladder
13. Post-op rads
(Expect to heal 14-21 days post-sx)
Water tight - good apposition, invert tissye so you close serosa to serosa (encourages fibrin seal) if possible
Do not penetrate the lumen with the sutures
Avoid impingement of ureters
Always engage submucosa (layer of strength)
Suture: PDS, Monocryl, Vicryl, Dexon, Prolene, Nylon (NOT BRAIDED - dissolves in urine)
Patterns: Many patterns successful, no influence on bursting strength
- Most water tight: One or 2 layer inverting pattern - Cushing followed by Lambert
- One or 2 layer appositional pattern - Simple continuous in submucosa followed by simple continuous in seromuscular layer
- Simple continuous in submucosa followed by Cushing
Fill in the blanks
Name the non-neoplastic bladder disease affecting the mucosa for which surgery is curative. A biospy confirms the diagnosis.
Is it more common in males or females?
What is the most common bladder tumor in the dog and cat?
What is the most common urinary tract tumor in the dog and cat?
Bladder (dogs and cats): Transitional Cell Carcinoma (TCC)
UT: Dog- TCC, Cat- Renal lymphoma
What is the typical signalment for dogs and cats who develop TCC?
Dogs: Older females (11y)
Cats: Middle-aged males
In cats TCC's tend to be found in the ____ of the bladder, while in dogs they tend to be found in the ____.
What are the predisposing factors for TCC? Which dog breed is predisposed to them?
The clinical signs associated with TCC are similar to _____. Metastatic disease can result in _____ and _____.
What modalities can be used to diagnose TCC? Is FNA indicated? Which test is used as a screening modality and why?
Positive contrast rads
US (evaluate LN's)
BTAT used are screening test because of the high rate of false positive
The risk of performing a partial cystotomy (with >1cm borders) to remove a TCC is the occurance of __________. When the trigone is involved, salvage procedures such as ________ or ________ can be performed.
T/F: Chemotherapy with agents such as piroxicam, cisplatin and mitoxantrone can be administered to treat TCC either in conjunction with surgery or not.
What is the most common developmental abnormality of male genitalia which involves the incomplete formation of the penile urethra? Which breed is predisposed to it?
What is the protrusion of urethral mucosa through the orifice called? What clinical signs are associated with this?
CS: Bleeding from prepuce, licking, red-purple mass
How would you manage a dog with a mild urethral prolapse (2 surgeries) ? What adjunct therapies might you recommend/perform?
Reduce and purse string
Urethropexy (using groove director which guides the scalpel and prevents it from going all the way through the penis; full thickeness sutures are placed through penile wall and urethra)
Adjunct: Castration, Airway surgery (for BAS)
What are the predisposing causes fo urethral prolapse? What is the typical signalment?
Brachycephalic airway syndrome (Dyspnea)
Sig: Young male brachycephalic dogs
A dog presents with a urethral prolapse. The protruding tissue is necrotic and ulcerated. What treatment is indicated?
Resection and anastomosis
3. 180 degree incision (to prevent mucosal retraction)
4. Suture (monofilament absorbable, NOT BRAIDED)