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Surgery 2 > Lecture 17 & 18: Bladder & Urethra (Exam 3) > Flashcards

Lecture 17 & 18: Bladder & Urethra (Exam 3) Flashcards

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1
Q

Define cystotomy

A

A surgical incision into the urinary bladder

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2
Q

Define cystostomy

A

The creation of an opening into the bladder

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3
Q

Define cystectomy

A

Removal of a portion of the urinary bladder

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4
Q

Define urethrotomy

A

An incision into the urethra

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5
Q

Define Cystolithiasis

A

Urinary bladder calculi

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6
Q

Define cystolithectomy

A

Removal of urinary bladder calculi

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7
Q

Define trigone

A

An area of the bladder is a smooth triangular portion of the mucous membrane

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8
Q

Define prepubic catherization

A

Temporary cystostomy usually performed to provide cutaneous urinary diversion in animals w/ urethral obstruction or trauma

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9
Q

Define Uroabdomen

A

Presence of urine in the abdominal cavity

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10
Q

Define urethrostomy

A

Creation of a permanent fistula into the urethra it is generally performed for irreparable or recurrent urethral stricture or to prevent repeated obstruction

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11
Q

What are the common indications for a cystotomy

A
  • Remove calculi
  • Repair trauma
  • Resect or biopsy neoplasms
  • Correct congenital abnorms
  • Eval of urinary tract infection resistant to tx
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12
Q

Describe the surgical approach for a cystotomy

A
  • Ventral midline approach of the caudal abdomen
  • Longitudinal incision made on the ventral or dorsal surface of the bladder away from the urethra
  • Place stay suture in the bladder
  • Use simple continuous (two layer closure if it is thin)
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13
Q

Why is ventral exposure often preferred

A

The ease of access & should be performed if ID or catheterization of ureteral openings is necessary

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14
Q

What is the goal of cystotomy

A

To obtain a watertight seal that will not promote

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15
Q

What closure is sufficient in thick & normal bladder walls

A

Single layer appositional closure

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16
Q

When is cystotomy not believed to be associated w/ formation of calculus

A

If absorbable monofilament suture is used

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17
Q

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

A

False you can not diagnose the type of stone on the basis of crystals found in the urine

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18
Q

When is surgical removal necessary

A
  • Calcium oxalate
  • Calcium phosphate
  • Silicate stones
  • Anatomic abnorms are present
  • If medical can’t be done
  • Need a culture
  • Stones are too large
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19
Q

Describe the surgical tech of removing stones

A
  • Perform cystotomy
  • Incise a small piece of bladder for culture
  • Remove the stones
  • Check the urethra for other stones
  • Examine the bladder for urachal diverticula
  • Use retrohyropropulsion (if this does not remove obstruction use urethrotomy)
  • Use a catheter to open the urethra (flush it)
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20
Q

When is retrohydropropulsion used

A

In male dogs to ensure there is no stones left in the urethral lumen by propelling urethral stones back into the bladder

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21
Q

How does retrohydropropulsion work

A
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22
Q

What should be done post stone removal

A
  • Submit the stones for mineral analysis
  • Perform abdominal radiographs
  • Monitor for obstruction or leakage
  • Sediment & pH monitored & UTI should be treated
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23
Q

What are some complications of cystotomy

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A
  • They are uncommon
  • Failure to remove all the stones is the most common complication
  • Urine leakage is possible
24
Q

What is the main common complication of a urethrotomy

25
Are urethral strictures common
No
26
What is a traditional lithotripsy
* Uses shock waves to break up stones in the kidney, bladder, or ureter * The tiny stones pass out of the body in the urine
27
What are the indications for a urethrotomy
* Males dogs to remove urethral calculi that can't be retrohydropropulsed into the bladder * Facilitate placement of catheters into the bladder * Occasionally for a biopsy of obstructive lesions
28
when & why is a cystotomy preferred
* When: If calculi can be advanced back into the bladder by retrohydropulsion * Why: to prevent possible post op urethral strictures
29
What are the common indications for a prescrotal urethrotomy
* Remove calculi from the distal penile urethra in dogs * Place foley catheters into the urinary bladder (if the catheter is of sufficient length & the obstruction is distal to the incision)
30
What are the indications for a perineal urethrotomy
* Occ. to remove calculi lodged @ the ischial arch * Place catheters into the bladder of large male dogs
31
What are the indications for a urethrostomy
* Recurrent obstructive calculi * Calculi that cannot be removed other surgical ways * Urethral stricture * Urethral or penile neoplasia or severe trauma * Preputial neoplasia req penile amputation
32
when is a scrotal urethrostomy preferred
If castration is an option & the lesion is distal to the scrotum
33
When is a perineal urethrostomy performed
Routinely in cats
34
What are the indications of a feline perineal urethrostomy
* To prevent recurrence of obstruction in male cats w/ feline idiopathic cystitis * Treat obstruction that cannot be eliminated by catheterization * Treat strictures secondary to urethral obstruction catheterization
35
Describe the tech of a prescrotal urethrotomy
* Ventral midline incision btw/ the scrotum & os penis * Incision is made over the urethral catheter * Calculi is removed & urethra flushed
36
Describe closure of a prescrotal urethrotomy
* May heal be secondary intention * Primary closure is preferred if the mucosa is healthy
37
What are the advantages of a prescrotal urethrotomy
* Less invasive * Good access to the distal penile urethra * Effective for calculi remove when hydropropulsion fails
38
What are the disadvantages of a prescrotal urethrotomy
* Potential for post op bleeding * Less ideal if multi or proximally located urethroliths exist
39
Describe the tech of a perineal urethrotomy
* Midline incision btw/ the anus & scrotum * Separate the bulbospongiosus muscle to access the urethra
40
Describe the closure of a perineal urethrotomy
Urethra & subQ tissue is closed w/ absorbable sutures
41
What are the advantages of perineal urethrotomy
* Access to more proximal urethral regions * Allows catheter placement when other approaches fail
42
What are the disadvantages of perineal urethrotomy
* Less commonly used * Must close to prevent subQ urine leakage * More technically demanding
43
Describe the tech of a canine perineal urethrostomy
Similar to perineal urethrotomy but the urethral mucosa is sutured to the skin
44
What is the advantage of a canine perineal urethrostomy
Last resort when other options fail
45
What are the disadvantages of a canine perineal urethrostomy
* High risk of urine scalding * Profuse hemorrhage due to cavernous tissue * Deep urethra leads to high suture tension & increases the risk of dehiscence * Not commonly performed
46
Describe the tech of a canine prescrotal urethrostomy
* Similar to prescrotal urethrotomy but the mucosa is sutured to the skin * Incision length is 6 to 8x the lumen diameter * Interupted or continuous mucosa to skin sutures are used for closure
47
What are the advantages of a canine prescrotal urethrostomy
* Easier to perform in thin dogs * Less hemorrhage than perineal site
48
What are the disadvantages of a canine prescrotal urethrostomy
* Higher stricture risk than the scrotal site * Not ideal if lesion is proximal
49
Describe the technique of a canine scrotal urethrostomy
* Castration & scrotal ablation performed together * Incision made over the urethra (more superficial here) * Urethral mucosa is sutured to the skin
50
What are the advantages of a canine scrotal urethrostomy
* Urethra is wider & more superficial * Less cavernous tissue so hemorrhage is reduced * Lower stricture risk * Better healing & lower complication rate
51
What are the disadvantages of the canine scrotal urethrostomy
* Req castration if intact * May not reach more proximal lesions
52
Describe the tech of a feline perineal urethrostomy
* Penis is amputated @ the bulbourethral glands * Urethra is dissected proximally beyond these glands * Mucosa is sutured to the skin
53
What is a critical step of the feline perineal urethrostomy
* Ensure the urethral stoma is > or = to 5 mm (should admit a mosquito hemostat to boxlock) * Failure predisposes to recurrent blockages
54
What are the advantages of a feline perineal urethrostomy
* High success rate in prevent recurrences * Improved quality of life in blocked cats
55
What are the disadvantages of a feline perineal urethrostomy
* Risk of hemorrhage * Risk of urine scalding * Stricture if the urethral diameter is inadequate * Surgical site infection & dehiscence is possible
56
What is the most critical step of a perineal urethrostomy
Pass a closed halsted mosquito hemostat up the urethra to ensure that the urethral width is adequate
57
What can happen if there is failure to perform the most critical step of a feline perineal urethrostomy
Can result in a urethral opening of insufficient diameter & predispose the px to urinary tract blockage & defeating the purpose of performing the surgery

Surgery 2 (22 decks)

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