Soft Tissue Surgery: Surgery of the Urinary Tract, Investigation, Urethra Flashcards
What are the developmental abnormalities of the kidneys?
Uncommon
Renal agenesis- not present
Renal dysplasia- disorganised parenchyma
Renal ectopia
Polycystic kidney disease
What are the indications for renal biopsy?
What should it be performed after?
What are the contraindications?
What are common complications?
Indications- renal mass (commonest), haematuria of upper tract, renal cortical disease, renal failure when the underlying cause cannot be determined, evaluation of severity/progression of renal disease
Perform after- haematology, serum biochem, urinalysis, diagnostic imaging, coagulation profile
Contraindications- anaemia/coagulopathy, oliguria, hypertension, urinary obstruction, hydronephrosis, cysts, perineal abscess, pyelonephritis, solitary functioning kidney
Complications- haemorrhage, haematuria, hydronephrosis, renal infarction, damage to the vasculature, AV fistula, infection, cyst formation, renal fibrosis
Methods- FNA in cortex, surgical, truecut/spring loaded instrument
How can kidney biopsy be approached?
Percutaneous- blind-
Ultrasound guided
Keyhole biopsy
Laproscopic biopsy
Ventral midline coeliotomy
Describe the surgical anatomy for finding left and right kidney
Right kidney- retract duodenum medially to reveal
Left kidney- retract colon medially
What is nephrotomy?
What is it used for?
How is haemostasis controlled?
How is it done?
Nephrotomy is an incision in to the kidney-
used for wedge biopsy of nephroliths
Haemostasis- assistant finger, vascular clamps or rumel rouniquiet on renal artery but for less than 20 mins
Small wedge using 11 blades, closet defect with 3/0 or 4/0 absorbable monofilament, suture in a simple interrupted or cruciate pattern
For calculi- bisectional or intersegmental nephrotomy- check the patency of the ureter
Closure- direct compression along incision for 5 mins, simple continuous on renal capsulre. Nephropexy- mattress suture through capsule and body wall
What are the clinical signs of neproliths?
How are they treated?
May be incidental, calculi more common in bladder
Clinical signs- lumbar/abdominal pain, haematuria, recurrent UTI, azotaemia
Treatment- medical management, calcium oxalate do not respond- surgical
What are the indications for ureternephrectomy?
What is done to the renal artery, vein and the ureter?
Indications- trauma, hydronephrosis, renomegaly, masses, management of single uretal ecopia, transplant
MUST HAVE OTHER FUNCTIONING KIDNEY
Double ligate renal artery, then ligate renal vein
Leave ureter attached to kidney then follow and ligate as close to the bladder as possible to reduce risk of ascending infection
What is a partial nephrectomy?
When could it be used?
Uncommon procedure- removal of part of the kidney
Suitable if benign, small, localised disease at the pole of a kidney
Unilateral nephrectomy previously performed
Salvages some renal function
Technically more difficult- post op haemorrhage, urine leaks, fistula
What are the different renal neoplasias?
Primary <2%
Cats- lymphoma usually bilateral
Dogs- renal cell carcinoma, transitional cell carcinoma, transitional cell papilloma, haemangiosarcoma, lymphoma, nephroblastoma, renal cystadenocarcinoma
What are the history and clinical signs of renal neoplasia?
What investigations can be done?
How is it treated?
Slow onset, haematuria, weight loss, depression/lethargy, inappetence, pyrexia, lameness, abdominal distension
Investigations- abdominal pain, haematology, serum biochem, radiography, CT, ultrasound, biopsy, check for metastasis
Treatment-
Lymphoma- chemotherapy
Unilateral renal neoplasia- with no great metastasis- ureteronephrectomy, surgery is palliative until metastases become apparent
What are the possible uncommon congenital bladder abnormalities?
Patent urachus- fetal communication between bladder and alantoic sac persisting
Vesicourachal diverticulum- external opening of urachus closes
Clinical signs- urine leakage, dermatitis, UTI
What are the indications for cystotomy?
Describe the approach and closure
What are the complications?
Removal of calculi, repair of trauma, biopsy of resection of bladder, masses, biopsy of bladder wall, repair of ectopic ureters
Approach-
ventral midline coeliotomy- umbilicus to pubis, isolate bladder from rest of abdomen with moistened lap swabs, place stay suture, ventral cystotomy- blade, suction urine, extend with scissors
Closure- monofilament suture- polydioxanone/poliglecaprone 3/0 or 5/0
single layer, simple interrupted or continuous, 2 layer inverting continuous pattern
Submucosa is strength holding layer, omentalisation, bladder heals quickly
Post op- hospitalisation to monitor urination
Complications- haematuria, dysuria, uroabdomen
What are the majority of bladder calculi?
What are the others?
What are the clinical signs?
How is it investigated?
What kind of calici require removal?
The majority are struvite or calcium oxalate
Others- urate, calcium phosphate, cystine, silica
Signs- haematuria, pollakiuria, stranguria, dysuria
Invesitgations- haematology, serum biochemistry, urinalysis, urine bacteriology
Plain radiograph- may not see urate, cystine but most
pneumocytography
Double- contract cystography
Ultrasounds, CT
Calcium oxalate and silica require removal
What causes bladder rupture?
What are the signs?
How is it diagnosed?
How is it managed?
Causes- trauma, bladder neoplasia, urethral obstruction by calculi or neoplasia, Iatrogenic
Signs- haematuria, anuria, dysuria, abdominal bruising/pain, can have no
Diagnosis- history, clinical exam, absence or urine, catheterisation, urethral obstruction at attempted catheterisation, azotaemia, dehydration, metabolic acidosis, hyperkalaemia, abdominocentasis, ultrasound
Management-
small tears will heal spontaneously, place indwelling catheter for 1-3 days, fluid therapy and urine drainage, normalise electrolyte levels
Exploratory laparotomy- identify and repair defect, closure as for cystostomy, lavage abdomen and suction fluid
What is the most common bladder neoplasia in dogs and cats?
What are potential others?
What can they lead to?
What are the clinical signs?
How is it investigated?
How is it treated?
Most common- transitional cell carcinoma
Other- lymphoma, rhabdomyosarcoma, adenocarcinoma
Local invasion- urinary obstruction, metastasis
Signs- dysuria, haematuria, polyakuria, systemically ill, UTI
Investigation- haematology, serum biochem, ultrasound, CT
Treatment- chemotherapy, NSAIDs, cystostomy tube, urethral stenting, partial cystectomy
