SASx Final Exam - Urinary System Flashcards
1
Q
How do you diagnose vesicourachal diverticulum?
A
Positive contrast cystography
2
Q
T/F: Perineal urethrostomy is successful in preventing LUT disease in cats
A
False
Perineal urethro_st_omy is a salvage procedure to treat FLUTDS and calculi in male cats. It increases incidence of bacterial cystitis and does not prevent FLUTDS
-
Indications for perineal urethro_st_omy in cats:
- Frequent obstructions
- Strictures
- Trauma
3
Q
T/F: Urine cytology is useful for diagnosing transitional cell carcinoma (TCC)
A
True
30% will exfoliate cells
4
Q
T/F: Even if hydronephrosis is caught late (> 4 weeks), the kidneys will likely be able to regain at least 75% function
A
False
If caught >4 weeks, you will be lucky to MAYBE regain 25% function
5
Q
With regard to urethral surgery:
- Urine diversion (increases/decreases) inflammation.
- Catheterization (increases/decreases) inflammation.
A
Urine diversion decreases inflammation. Catheterization increases inflammation
6
Q
What is the most common surgery performed on the urinary bladder and what are its indications?
A
cystotomy
- Most common surgery of the bladder
- Most common procedure for urolith removal
-
Indications:
- Urinary tract obstructions
- No medical options
- Other retreival methods have failed
7
Q
What is the most common cause of ureteral trauma?
A
ovariohysterectomy!
8
Q
T/F: Second intention healing of the urethra is the preferred method of closure for a prescrotal urethrotomy
A
True
- less risk of stricture and fewer complications associated with suturing the small urethral lumen*
- The down side to second intention healing is that your patient is likely to have profuse hemorrhage from the area, so they will need to be hospitalized for a few days*
9
Q
What is the most common renal neoplasia seen in felines?
A
renal lymphoma
- Most common renal neoplasia in the cat
- MST depends on stage
- Surgery may not be indicated
10
Q
T/F: Radiography is helpful for diagnosing calcium oxalate, cystine, and urate stones in the bladder
A
False
Cystine and urates are radiolucent!
11
Q
What is the composition of more than 40% of nephroliths?
A
Calcium Oxalate (CaOx)
12
Q
T/F: You can easily rule out bladder rupture by palpation. If the bladder is palpable, rupture is not present
A
False
-
In any trauma case, consider bladder rupture until you can rule it out
- Palpable bladder does not rule out
- Normal urination does not rule out
- Urine retrieval by catheter does not rule out
13
Q
What surgery is being performed in this image?
A
partial nephrectomy
- Not often performed; technically more difficult than full nephrectomy
- Preserves renal function, but higher incidence of post-op hemorrhage
- Surgical steps:
- Occlude blood supply, Incise and peel back capsule, Pass suture with straight needle, Divide in thirds, Tighten sutures, Loosen tourniquet, Close capsule
14
Q
What is the most common benign neoplasia seen in the kidneys?
A
renal adenoma
15
Q
When closing the urinary bladder, serosa to serosa contact encourages __________, which helps ensure a water tight closure
A
fibrin seal
When closing the urinary bladder, serosa to serosa contact encourages fibrin seal, which helps ensure a water tight closure
16
Q
T/F: Pyelonephritis is an indication for removal of the kidney
A
True
17
Q
Where does the urinary bladder receive its nerve supply?
A
hypogastric n. (sympathetic) and pelvic n. (parasympathetic)
18
Q
What is the most common urethrostomy site in cats?
A
perineal
19
Q
________ urethrotomy is indicated for calculi lodged between scrotum and ischial arch
A
perineal urethrotomy
perineal urethrotomy is indicated for calculi lodged between scrotum and ischial arch
-
Try to avoid in dogs if possible
- Difficult procedure (urethra deeper)
- Increase risk of infection
- Usually suture urethrotomy incision
20
Q
T/F: One or two layer closure is acceptable for closure of the urinary bladder
A
True
21
Q
What is the most common urethrostomy site in dogs?
A
scrotal
22
Q
If you suspect cystic calculi in your patient but you’re unable to view any stones on radiographs, what other diagnostic modalities are useful?
A
pneumocystography, double contrast cystography, ultrasound
All three are about equally effective in detecting radiolucent stones
23
Q
In male cats, urethral obstruction is most often caused by:
A
mucus plug/crystals
Occurs most commonly in the distal 1/3 of the urethra in male cats
24
Q
What size suture is typically used for closure of the urinary bladder?
A
3-0
Options include PDS, Monocyl, Vicryl, Dexon, Prolene, Nylon
25
Where is a **urethrotomy** typically performed in our canine patients?
**prescrotal area**
*just caudal to the caudal aspect of the os penis (between the scrotum and the os penis)*
* *Very superficial area*
* *Less cavernous tissue*
* *incision is made right over the urethra*
26
What are the indications for performing a **cystopexy**?
* **Tube cystotomy**
* **Perineal hernia**
* **Urinary incontinence associated with pelvic bladder**
27
When performing a **prescrotal urethrotomy**: after you've made the incision on the ventral midline, you want to isolate the __________ muscle and deviate it laterally to gain access to the prescrotal urethra
**retractor penis muscle**
* When performing a prescrotal urethrotomy: after you've made the incision on the ventral midline, you want to isolate the **_retractor penis muscle_** muscle and deviate it laterally to gain access to the prescrotal urethra*
* Once you have access, you'll make an incision into the urethra to find the stone*
28
If your patient has a non-functional kidney or severe parenchymal damage, what is the surgical treatment of choice?
**Nephroureterectomy**
* (Surgical removal of the kidney and its ureter)*
* Neff-row-your-eat-er-ek-to-mee*
29
What is the treatment option for **ectopic ureterocele**?
**Neoureterocystostomy with ureterocelectomy**
*knee-yo-your-eat-er-oh-sis-tossed-to-me with your-eat-er-oh-sell-ek-to-me*
30
Progressive dilatation of the renal pelvis and atrophy of the renal parenchyma is termed:
**hydronephrosis**
31
What is the treatment of choice for **persistent urachus**?
**surgical removal of the urachal tube**
32
T/F: Surgical correction of the airways may be indicated in cases of **urethral prolapse**
**True**
*Especially in brachycephalic breeds, this condition may be worsened by straining to breath*
33
The **urinary bladder** is attached by ligaments. Which of those ligaments should be avoided during surgery?
**lateral ligaments**
*The lateral ligaments contain the distal ureters.*
34
What procedure is being performed here?
**retrograde hydropulsion**
*This is performed in canine patients only!*
35
T/F: **Perineal urethro**_st_**omy** is the preferred approach in the dog?
**False**
*Only indicated when a more distal approach is not possible (tissue damaged or not possible)*
36
Between **dorsal cystotomy** and **ventral cystotomy**, which one is preferred?
**ventral approach is preferred**
*Increased exposure of the bladder neck, can visualize ureteral orifices*
37
T/F: There is a very high incidence of **urethral obstruction** in female cats with LUTD
**False**
*There is a very high incidence of urethral obstruction in **_male cats with LUTD_***
38
T/F: In the case of **bladder rupture** in a metabolically unstable animal, IV fluids are indicated
**True**
* Patients with bladder rupture should always be stabilized prior to surgery! It sounds counter-intuitive, but you want to give them fluids to help correct acid-base status, electrolytes, etc.*
* Often times the clinician will perform an abdominocentesis as they are giving fluids to allow the fluid to drain*
39
While performing a cystotomy all willy-nilly, you accidentally cut the **pudendal nerve**. What complication are you likely to observe in this patient?
**Involuntary bladder emptying**
*The pudendal nerve supplies somatic innervation to the external bladder sphincter and striated musculature of the urethra*
40
What diagnostic modality is used to confirm the exact location of **ureteral trauma**?
**IV urography**
41
What are some indications for a **tube cysto**_st_**omy**?
**any need for urinary diversion**
## Footnote
*Stabilize patient with LUT obstruction (cannot catheterize), bladder or urethral trauma, bladder or urethral surgery, neurologic bladders*
42
What the f\*\*\* is that?
**Giant Kidney Worm**
*Dioctophyme renale*
43
What is the most common neoplasia seen in the canine **urinary bladder**?
**transitional cell carcinoma (TCC)**
44
T/F: **Transitional cell carcinoma (TCC)** is the most common urinary tract neoplasia in cats
**False**
* *_Renal lymphoma_ is the most common urinary tract tumor in cats*
* *TCC is the most common _bladder tumor_ in cats (and the 2nd most common urinary tract neoplasia)*
* *TCC seems to have an affinity for the apex of the bladder in cats (compare this to the most common location in dogs)*
45
What is the procedure of choice for treating trauma to the **proximal ureter**?
**ureteroureterostomy**
* *Procedure of choice for proximal ureter*
* *Cannot reimplant*
* *Requires magnification*
* *Extremely difficult*
* *High incidence of complications (Strictures, Dehiscence)*
* *Catheterize through cystotomy*
* *Avoids engaging back wall with the suture*
* *Angle cut ends*
* *Suture under magnification*
46
The most common cause of **urethral obstruction** in male dogs is:
**calculi**
*In male dogs, normally at the ischial arch or just caudal to os penis*
47
Surgical attachment of the **urinary bladder** to the abdominal wall is termed:
**cystopexy**
48
What is the most common **urachal abnormality** that we'll see in dogs?
**vesicourachal diverticulum**
*External opening is closed, bladder attachment patent*
49
T/F: The procedure shown below does _not_ cause damage to the nephrons
**True**
*_Pyelolithotomy_ does not cause damage to the nephrons*
50
What are you specifically looking at when performing an abdominocentesis for confirmation of **bladder rupture**?
**urea and creatinine**
* *Urea molecule equilibrates across the peritoneum, but creatinine molecule is too large*
* *Urea in peritoneal fluid = serum urea*
* ***Creatinine in peritoneal fluid \> serum creatinine***
* ***If creatinine is higher in peritoneal fluid, then you have confirmed the presence of urine in the abdominal cavity (there would be no other reason for this fluid to have a higher [creatinine] than serum***
* *Potassium will also be higher in abdominal fluid*
51
What are some predisposing factors for development of **transitional cell carcinoma (TCC)**?
* **Obesity**
* **Insecticide exposure**
* **Herbicide**
* **Cyclophosphamide**
52
T/F: **Hematuria** is considered an important indication for renal surgery
**False**
*Hematuria is NOT an indication for surgery*
53
The **kidney's** blood supply comes from:
**renal artery**
*The kidneys are usually supplied by a single renal artery, which arises from the aorta between the cranial and caudal mesenteric arteries. The renal artery divides into dorsal and ventral branches before entering the kidney at the hilus. Occasionally more than one renal artery is present (most common on left side). The renal veins empty into the caudal vena cava, caudal to the hepatic veins.*
54
More than \_\_\_\_% of the urethra must be narrowed before a patient shows clinical signs of **urethral stricture**
**60%**
*More than _60%_ of the urethra must be narrowed before a patient shows clinical signs of urethral stricture*
* *Creates increased risk of obstruction*
* *Usually caused by trauma*
* *Urethral surgery*
* *Trauma by uroliths*
* *Iatrogenic from catheterization*
* *Healing after minor trauma*
55
When performing a **perineal urethro**_st_**omy**, you want to dissect to the level of the _________ gland
**bulbourethral gland**
## Footnote
*this will be your anatomical landmark to make sure you're in that pelvic urethra where the urethra widens up significantly*
56
This disorder is characterized by failure of one or both ureters to terminate in the normal location:
**ectopic ureter**
57
If your patient presents with an acute **urethral prolapse** and he's not showing symptoms (no bleeding, ulceration, etc), what is your treatment protocol?
**reduce with aid of large catheter, place purse string suture, leave for 5 days**
58
If hydropulsion is unsuccessful, what surgical procedure is indicated for removal of **urethral calculi**?
**urethrotomy**
59
What is the most common clinical sign associated with **ectopic ureters**?
**urinary incontinence**
60
Name a few complications associated with **tube cysto**_st_**omy**:
* **Inadvertent tube removal**
* **Pet chewing on tube**
* **Breakage of mushroom tip**
* **Fistula formation after removal**
* **Urine leakage around tube**
* **Rectal prolapse**
* **Inflammation around tube site**
* **Hematuria**
* **Inadvertent tube bag removal**
* **Bandage sores**
* **Breakage of anchoring sutures**
61
What is the most common **renal neoplasia** seen in _canines_?
**renal cell carcinoma**
* *Increased incidence in males*
* *Incidence increases with age*
* *MST 6.8 months*
* *Nephroureterectomy and chemotherapy*
62
Which of the following is NOT an indication for **nephroureterectomy**?
* Hematuria secondary to blunt trauma to the abdomen
* Avulsion of the renal pedicle
* Unilateral renal adenocarcinoma
* Unilateral uncontrollable pyelonephritis
**Hematuria secondary to blunt trauma to the abdomen**
63
What's that?
**One of the lateral ligaments of the bladder**
*This is where the ureters enter into the bladder wall, so you want to avoid these!*
64
How do you diagnose **ureterocele**?
**IV urography**
*Will see 'cobra head sign'*
65
Identify this non-neoplastic lesion in the **urinary bladder** that may be confused with neoplasia:
**polyploid cystitis**
66
What's that?
**ventral ligament of the bladder**
67
T/F: Canine **bladder tumors** are very _uncommon_, but almost all of the occurrences are malignant
**True**
* *Uncommon (1% of all neoplasias)*
* *97% malignant*
* *TCC most common*
* *Older females (11 years)*
* *Seems to have an affinity for the _trigone_ of the bladder*
* *Most commonly seen in Scottish terriers*
68
What is the treatment option for **intravesicular ureterocele**?
**Ureterocelectomy**
*(excision of the ureterocele)*
69
Surgical formation of a permanent opening of the **urethra** at a new site is termed:
**urethro**_st_**omy**
* *_Indications_*
* *Permanent damage to the distal urethra*
* *Recurrent urethral obstruction*
* *Obstruction that cannot be retropulsed or removed by urethrotomy*
70
What is the preferred method for **renal biopsy**?
**ultrasound-guided**
* *Advance needle into prepared area*
* *Penetrate capsule*
* *Can identify target lesions*
71
What is the most common type of **ectopic ureter**?
**intramural**
## Footnote
*An intramural ectopic ureter enters the bladder at the correct location, but tunnels down the wall of the urethra before opening up. *
72
What is the most common indication for **ureteral surgery**?
**Ureterolithiasis**
*(calculi in the ureter)*
73
Where does the **urinary bladder** receive its blood supply?
**caudal vesicular artery** and **prostatic/vaginal artery**
74
T/F: **Electrohydraulic lithotripsy** is a non-surgical treatment option for cystic calculi
**True**
75
T/F: Regardless of the type of stone present, dietary modification is indicated for all cases of **cystic calculi**
**False**
* *Depends on the type of stone*
* *Incorrect diet can worsen condition!*
* *Patient cannot be obstructed*
76
What is the name for this procedure that looks like a very aggressive dog-hug?
**voiding hydropulsion**
*non-surgical treatment option for cystic calculi*
* *Stones must be very small (smaller than urethral diameter)*
* *With the patient under sedation, Inject saline into the bladder to distend the bladder. Hold the patient upright and express the bladder manually*
77
What are the indications for **renal transplants**?
* **Irreversible acute renal failure**
* **Decompensated chronic renal failure**
* **Polycystic disease**
78
What diagnostic modality provides the most reliable diagnosis for **bladder rupture**?
**positive contrast urethrocystogram**
*Will see leakage of contrast material in the abdomen. As it continues to leak, it will highlight the intestinal loops.*
* *_Other diagnostic modalities_:*
* *Plain radiographs*
* *Can see free abdominal fluid; Absence of bladder; Decreased serosal detail*
* *Ultrasound*
* *Free fluid, concurrent injuries, guide for abdominocentesis, helps determine source of injury*
79
T/F: **Pyelolithotomy** is contraindicated if renal disease is present
**False**
*Pyelolithotomy is **_preferred_** if renal disease is present because it does not affect RBF or GFR; does not require occlusion of blood supply*
80
T/F: The **urinary bladder** usually regains 100% of its strength 2-3 weeks post-surgery
**True**
81
What is the most severe complication associated with obtaining a **renal biopsy**?
**severe hemorrhage**
82
When occluding the vessels of the kidney, it's important to clamp the vessels no longer than \_\_\_\_\_\_\_\_. Otherwise you'll begin to develop permanent damage to the kidney
When occluding the vessels of the kidney, it's important to clamp the vessels no longer than **_20 minutes_**. Otherwise you'll begin to develop permanent damage to the kidney
83
This is the most common developmental abnormality of male genitalia:
**hypospadias**
* Incomplete formation of penile urethra, Urethral orifice can occur anywhere along penis*
* \*\**
84
Creation of a **urethro**_st_**omy** on the ventral body wall cranial to the pubis:
**antepubic urethro**_st_**omy**
* *Indications*
* *Recurrent pelvic urethral obstruction*
* *Failed perineal urethrostomy that cannot be revised*
* *Ventral midline in female dogs and all cats*
* *Parapreputial in male dogs*
85
You're considering ureteral surgery for your patient with a unilateral obstruction. You also find elevated BUN and creatinine. What does this indicate?
**bilateral renal disease**
*If there is azotemia with unilateral obstruction, your patient has bilateral renal disease*
86
Surgical incision of the renal pelvis of the kidney for removal of a kidney stone is termed:
**\*\*Pyelolithotomy\*\***
* *Can be used to remove calculi when proximal ureter and renal pelvis are dilated*
* *This area is hidden by kidney when not dilated*
* *_Does not require occlusion of blood supply_*
* *Does not damage nephrons*
* *Longitudinal incision*
* *Catheterize and flush ureter*
87
How do you diagnose **urethral trauma**?
**positive contrast urethrogram**
*Plain radiographs are non-diagnostic!*
88
What is the most common cause of **renal trauma**?
**hit by car (blunt trauma)**
* *Most commonly from HBC/blunt trauma*
* *Hematuria is not indication for surgery*
* *Diagnosis*
* *Contrast excretory urography*
* *Exploratory celiotomy*
* *Ultrasound*
89
T/F: If **hydronephrosis** is caught early (\< 1 week), the kidney will likely regain full function
**True**
*Especially if it's just a partial obstruction*
90
Is there a higher incidence of urine scald with a **scrotal urethro**_st_**omy** or a **prescrotal urethro**_st_**omy**?
**prescrotal urethro**_st_**omy**
91
\_\_\_\_\_\_\_\_\_\_ is the holding layer/layer of strength of the **urinary bladder**
**submucosa!**
*(just a reminder in case it definitely comes up again... the submucosa is also the holding layer in the esophagus... and really pretty much all the inside things)*
92
What is the main goal of **perineal urethro**_st_**omy**?
**mobilization of the urethra**
93
T/F: After performing a **nephrolithotomy**, the kidney can be closed using "sutureless closure"
**True!**
* *Sutureless closure*
* *Hold for 5 minutes*
* *Forms fibrin seal*
* *Suture capsule only*
* *Release vascular clamp*
94
Treatment for **ureteral trauma** is based on time, location, and severity. What surgical treatment is typically the least expensive and minimizes complications?
**Nephroureterectomy**
*Other options include ureteroureterostomy (ureteral anastomosis), neoureterocystostomy (ureteral reimplantation), urinary diversion*
95
Formation of a cyst along the **urachus** is termed:
**urachal cyst**
you're welcome.
* *Secreting urachal epithelium persists*
* *Usually isolated segment*
* *Usually asymptomatic*
* *Surgical excision if clinical signs develop*
