Exam 3: Lecture 17/18 - Surgery of the Bladder & Urethra

Question 1

what does cystotomy mean

Answer 1

a surgical incision into the urinary bladder

Question 2

what does cystostomy mean

Answer 2

the creation of an opening into the bladder

Question 3

what does cystectomy mean

Answer 3

the removal of a portion of the urinary bladder

Question 4

what does urethrotomy mean

Answer 4

an incision into the urethra

Question 5

what does cystolithiasis mean

Answer 5

urinary bladder calculi

Question 6

what does cystolithectomy mean

Answer 6

removal of urinary bladder calculi

Question 7

what does trigone mean

Answer 7

area of the bladder is a smooth triangular portion of the mucous membrane at the base of the bladder where the ureters empty

Question 8

what does prepubic catheterization mean

Answer 8

usually performed to provide cutaneous urinary diversion in animals with urethral obstruction or trauma

Question 9

what does uroabdomen mean

Answer 9

presence of urine in the abdominal cavity

Question 10

what does urethrostomy mean

Answer 10

creation of a permanent fistula into the urethra

Question 11

when is a urethrostomy usually performed

Answer 11

for irreparable or recurrent urethral stricture or to prevent repeated obstruction

Question 12

what is this a picture of

Answer 12

trigone area of the bladder

Question 13

when is a cystotomy indicated

Answer 13

1. removal of calculi
2. repair trauma
3. resect or biopsy neoplasms
4. correct congenital abnormalities
5. eval of urinary tract infection resistant to treatment

Question 14

T/F: bladder location varies depending on the amount of urine it currently contains

Answer 14

TRUE!

Question 15

where does the bladder lie when it is empty

Answer 15

primarily within the pelvic cavity

Question 16

what are the 4 parts of the bladder

Answer 16

1. apex
2. body
3. neck
4. trigone

Question 17

what is the surgical approach for a cystotomy

Answer 17

1. ventral midline approach to the caudal abdomen from the umbilicus caudal to the pubis
2. longitudinal generally is made on the ventral or dorsal surface of the body of the bladder but AWAY from the urethra

Question 18

T/F: ventral exposure of the bladder is often preferred owing to ease of access and should be performed if ID or catheterization of ureteral openings is necessary

Answer 18

TRUE

Question 19

what is the goal of a cystotomy closure

Answer 19

to obtain a watertight seal that will not promote formation of calculi

Question 20

T/F: a single layer appositional closure is sufficient if the bladder wall is thick

Answer 20

true

Question 21

T/F: in normal bladders, a single-layer appositional suture pattern is NOT typically adequate for a watertight seal

Answer 21

false, it IS adequate

Question 22

what type of suture is not believed to be associated with formation of calculus in the bladder

Answer 22

monofilament suture

Question 23

what should we do if hemorrhage is expected to be severe

Answer 23

suture the bladder mucosa as a separate layer may be considered to decrease postoperative bleeding

Question 24

what is the urethra of a male dog composted of (3 parts)

Answer 24

prostatic, membranous, and penile portions

Question 25

Where are most canine uroliths found

Answer 25

in the bladder or urethra

Question 26

what are the 2 most common types of canine uroliths

Answer 26

struvite and calcium oxalate calculi

Question 27

T/F: struvite calculi in dogs are frequently associated with infection

Answer 27

TRUE!

Question 28

why do we analyze stones

Answer 28

to determine the stone type and aid in planning subsequent medical management to prevent recurrence

Question 29

T/F: You can diagnose the type of stone on the basis of the crystals found in the urine

Answer 29

FALSE! You cannot

Question 30

T/F: feline struvite formation usually occurs without UTI

Answer 30

true

Question 31

for what type of stones do we use medical dissolution

Answer 31

1. struvite calculi 2. urate calculi 3. cystine calculi

Question 32

for what type of stones do we use surgery for removal

Answer 32

1. calcium oxalate 2. calcium phosphate 3. silicate stones

Question 33

what are the 4 disadvantages of medical dissolution

Answer 33

1. cost 2. need for frequent rechecks 3. possible urethral obstruction in males 4. poor owner compliance with maintaining a suitable dietary regimen

Question 34

what are 4 reasons we should consider surgery for stones

Answer 34

1. concurrent or predisposing anatomic abnormalities are present 2. medical dissolution is not possible or is inadvisable 3. bladder mucosal culture is required 4. stones are large enough that is attempting voiding hydropropulsion is likely to cause urethral obstruction

Question 35

what are the 2 surgical approaches for stone removal

Answer 35

1. cystotomy should be performed preferentially over urethrotomy if stones can be flushed into the bladder pre-op or intra-op 2. cystotomy plus scrotal urethrostomy may be the most effective treatment in preventing recurrence of clinical signs in Dalmatians with urate calculi

Question 36

what are the BASIC surgical techniques for bladder stones

Answer 36

1. perform cystotomy 2. incise small piece of bladder for culture and histopath 3. remove bladder stones 4. check urethra for additional calculi 5. examine bladder for urachal diverticula and excise if needed

Question 37

what technique is being shown here

Answer 37

retrohydropropulsion

Question 38

what should we do after surgery for our patients to make sure it is successful

Answer 38

1. submit stones for mineral analysis and possibly for microbial culture 2. perform abdominal rads to confirm complete removal of radiopaque calculi 3. closely monitor for urinary obstruction or leakage 4. urine sediment and pH should be monitored regularly and UTI treated promptly

Question 39

what are some complications of cystotomy

Answer 39

1. failure to remove all the stones 2. urine leakage

Question 40

T/F: complications of cystotomy are very common

Answer 40

false, they are uncommon

Question 41

what are 2 complications of urethrotomy

Answer 41

1. main complication of urethrotomy is hemorrhage 2. urethral stricture is uncommon

Question 42

T/F: you can laparoscopically remove bladder stones

Answer 42

true

Question 43

other than with a scope, what are other nonsurgical stone removal techniques

Answer 43

1. traditional lithotripsy 2. laser lithotripsy via cystoscopy using a holmium:yttrium-aluminum-garnet

Question 44

what is the instrument called

Answer 44

bladder spoon

Question 45

when is prepubic catheterization indicated

Answer 45

urinary obstruction, traumatized urethra, surgically repaired urethra, bladder atony secondary to neurologic disease

Question 46

what are these used for

Answer 46

cystostomy (prepubic catheterization)

Question 47

when is a urethrotomy indicated

Answer 47

1. in male dogs to remove urethral calculi that cannot be retrohydropropulsed into bladder 2. facilitate placement of catheters into bladder 3. occasionally for a biopsy of obstructive lesions

Question 48

when is a prescrotal or perineal urethrotomy performed

Answer 48

depending on the level of the obstruction lesion

Question 49

T/F: to prevent possible postop urethral stricture, a cystotomy is preferred over urethrotomy

Answer 49

true! esp if calculi can be advanced back into the bladder via retrohydropulsion

Question 50

when is a prescrotal urethrotomy indicated

Answer 50

1. remove calculi from the distal penile urethra in dogs 2. place foley catheters into urinary bladder is of sufficient length and if the obstruction is distal to the proposed urethrotomy incision

Question 51

how do we close prescrotal urethrotomy

Answer 51

1. can be left to heal by secondary intention 2. primary closure is preferred if mucosa is healthy and if adequate apposition of the urethral mucosa can be achieved

Question 52

what procedure is being shown in this picture

Answer 52

prescrotal urethrotomy

Question 53

how should we do primary closure of a prescrotal urethrotomy

Answer 53

1. close urethra with simple interrupted or continuous appositional absorbable suture 2. place first layer in urethral mucosa and corpus spongiosum 3. appose SQ and skin with simple interrupted or continuous subcuticular suture pattern 4. remove urinary catheter

Question 54

what are the indications for perineal urethrotomy

Answer 54

1. occasionally used to remove calculi lodged at ischial arch 2. place catheters into bladder of large male dogs

Question 55

T/F: perineal urethrotomy is less commonly indicated than urethrotomy at other sites

Answer 55

true!

Question 56

should we close a perineal urethrotomy site?

Answer 56

yes! to prevent subcutaneous urine leakage

Question 57

what procedure is being done in this picture

Answer 57

perineal urethrotomy

Question 58

what are the 5 indications of urethrostomy

Answer 58

1. recurrent obstructive calculi that cant be managed medically 2. calculi that cannot be removed by retrohydropropulsion or urethrotomy 3. urethral stricture 4. urethral or penile neoplasia or severe trauma 5. preputial neoplasia requiring penile amp

Question 59

T/F: depending on the site of the lesion, ureterostomy in dogs can be prescrotal, scrotal, perineal, or prepubic

Answer 59

TRUE!!

Question 60

_____ urethrostomy is preferred if castration is an option and if the lesion is distal to the scrotum

Answer 60

scrotal

Question 61

what species are perineal urethrostomy routinely performed

Answer 61

cats

Question 62

what do PUs often cause in canines

Answer 62

unacceptable urine scalding

Question 63

when are PUs used in dogs

Answer 63

in dogs that have urinary problems that will not be resolved by a scrotal or prescrotal urethrostomy

Question 64

why is a canine scrotal urethrostomy preferred over perineal or prepubic

Answer 64

because the urethra is wider and more superficial and is surrounded by less cavernous tissue here than at other sites

Question 65

how do we do a canine scrotal urethrostomy

Answer 65

1. if dog is intact, castrate him and excise the scrotum 2. place a sterile catheter into the urethra to the level of the ischial arch or beyond 3. make a midline incision over the urethra through the SQ tissue 4. ID the retractor penis muscle, mobilize it, retract it laterally 5. use a 11 or 15 scalpel blade, make a 3 to 4cm incision into the urethral lumen 6. suture the urethra as for prescrotal urethrostomy

Question 66

when is a feline PU indicated

Answer 66

1. to prevent recurrence of obstruction in male cats with feline idiopathic cystitis 2. to treat obstruction that cannot be eliminated by catheterization 3. to treat strictures secondary to urethral obstruction and catheterization

Question 67

what procedure is occurring in this picture

Answer 67

feline PU

Question 68

how to we check the urethral width of a feline PU

Answer 68

pass a closed halstead mosquito hemostat up the urethra and they should be able to be passed to the level of the boxlocks without resistance (about 5mm)

Question 69

T/F: Failure to pass a closed halstead may result is urethral opening of insufficient diameter and predispose your patient to urinary tract blockage

Answer 69

true!!

Question 70

what procedure is this a result of

Answer 70

feline PU