Kidney & Ureter Sx Flashcards
(22 cards)
Obj: Understand surgical procedures and when they are indicated
Obj: Know the surgical options for ureteral obstruction
Obj: Know the clinical signs, diagnosis, and treatment of ectopic ureters
What are some indications for Kidney/Ureter surgery?
- Tumors
- Hydronephrosis
- Abscess
- Ectopic ureters
- Urolithiasis
- Biopsy
- Trauma
What are the preoperative considerations for kidney/ureter surgery?
- Clinical signs, physical exam
- CBC, Serum chemistry, UA
- Blood pressure
- Abdominal Radiographs
- Abdominal ultrasound
- Renal function?
- Ensure proper pre-op hydration
What surgical approach is used in kidney/ureter surgery
- Ventral Midline approach
- Xiphoid to pubis
What surgical procedures involving the kidney/ureter are commonly done?
- Nephroureterectomy/nephrectomy
- Complete - most common
- Partial - Rare
- Biopsy
- Renal Transplantation
- Ureteral surgery
What is a Nephrectomy? When is it indicated?
- Complete removal of kidney and associated ureter
- Indications:
- Neoplasia
- <2% of all canine cancer
- Renal Carcinoma - Dog
- Lymphoma - Cat (non surgical)
- Severe hydronephrosis
- Secondary to ureteral obstruction
- Dilation of renal pelvis
- Atrophy of renal parenchyma
- Abscess/pyelonephritis
- Rare - associated with pyelonephritis, nephrolithiasis
- Trauma - extremely rare
- Neoplasia
What are the general steps to a nephrectomy?
- Free attachments bluntly
- Rotate kidney medially
- Ligate vessels
- multiple renal arteries
- 13% dogs
- 10% cats
- Left> right
- multiple renal arteries
- Ligate and transect ureter at level of bladder
What are the indications for Ureteral surgery?
- Ectopic ureters
- Ureterolithiasis
- ureteral trauma
What is an Ectopic Ureter? signs?
- Congenital
- Abnormal location of ureteral openings distal to the trigone
- Sign: urinary incontinence since weaning
which animal/sex is more commonly affected by ectopic ureters?
- Dogs >>> cats
- Females >>> males (20:1)
What are the different types of ectopic ureters?
- Intramural:
- ureter tunnels in wall of bladder and has abnormal location of opening distal to trigone
- Extramural:
- ureter enters bladder at abnormal location distal to trigone without tunneling in bladder wall
How are ectopic ureters diagnosed?
- Rule out UTI, urolithiasis
- Abdominal ultrasound
- Concurrent abnormalities
- Cystoscopy
- CT scan
- Excretory urogram
- consider urethral pressure profilometry
How are ectopic ureters repaired?
- Intramural:
- Neoureterostomy
- Cystoscopic laser treatment
- Extramural:
- Ureteroneocystostomy
What surgical complications are common to ectopic ureter repair?
- Stricture ⇢ hydronephrosis
- Incontinence resolved in 22-59% of patients
- additional 7-28% improved w/ medical management
- Surgery + medical management 50-75%
What is a ureterotomy?
- Incising into the ureter
What are the potential complications of a ureterolith
- Hydroureter & hydronephrosis
- loss of renal function
How is the incision for a ureterotomy repaired?
- 5-0 to 7-0 simple interrupted suture
What are the potential complications of ureterotomy?
- Leakage
- Stricture Formation
- inability to locate and/or remove all stones
What are the treatments for ureterolithiasis?
- Ureterotomy
- Subcutaneous ureteral bypass (SUB) system - cats
- Ureteral stenting - dogs
How are SUBs cared for?
- Flushing every 3-6 mo w/ ultrasound evaluation
- Lifelong commitment
- urine culture performed at every flush
- Management of chronic kidney disease
