Surgery of the ureters Flashcards Preview

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Flashcards in Surgery of the ureters Deck (35)

What breed, sex, and age is more likely to develop an ectopic ureter?

  • Breeds
    • Siberian husky
    • Labrador/golden retriever
    • West highland terrier
  • Age--young
  • Sex--females (canine)
  • (Rare in cats)


What are the clinical signs of an ectopic ureter?

  • Incontinence
  • Fails to house train
  • UTI
  • Urine scalding


How do you diagnose an ectopic ureter?

  • Excretory urography (76% accurate)
    • Best if combine with pneumocystography
    • Fluoroscopy
  • CT
  • U/S
  • Cystoscopy 


What are the classifications of ectopic ureter? What's the difference?

  • Extramural--enters into abnormal location (neck, urethra, or vagina)
  • Intramural
    • Most common (dogs)
    • Enters normally but exits abnormally


What are the treatments for ectopic ureters?

  • Neoureterocystostomy
    • End to side--extramural
    • Side to side--intramural
  • Laser transection


What is an end-to-side neoureterocystostomy?

  • Re-implantation of ureter for extramural EU
    • Not as common
  • Ligate ureter, transect where it is entering urethra
  • Grasp ureter through cystotomy
  • Transplant to more normal location
  • Spatulate and suture


What is a side-to-side neoureterocystostomy?

  • Intravesicular diversion for intramural EU
  • cystotomy incision-->find where it's exiting, occlude
  • Slit incision in an area that's more normal (i.e. trigone)
  • Suture mucosa of ureter to mucosa of bladder to create permanent opening


What is the prognosis for an ectopic ureter?

  • Other functional abnormalities may still exist
  • Difficult surgery but high improvement rate (60%)
  • Those that don't improve can be put on phenylpropanolamine (PPA) to help (90% improvement)


Differentiate between the two types of ureteroceles

  • Ectopic--have an ectopic ureter as well (neck/urethra)
  • Intravesicular--normal entrance/exit but have ureterocele over the ureteral orifice 


What are the clinical signs associated with a ureterocele?

  • UTI
  • Incontinence
  • Azotemia if obstruction


How do you diagnose a ureterocele?

  • IV urography
  • Cobra head sign
  • U/S


What are the treatments for ureteroceles?

  • Intravesicular = ureterocelectomy
  • Ectopic = neoureterocystostomy with ureterocelectomy


What are the causes of ureteral trauma?

  • #1 cause = iatrogenic
    • ​Spay--snag ureter with spay hook 
    • Clamp injury--60 min
  • Blunt trauma
  • Obstruction


How do you diagnose ureteral trauma?

  • Uroretroperitoneum
  • Uroabdomen
  • Rads
  • IV urography (localizes lesion)


What treatments are available for ureteral trauma?

  • Nephroureterectomy
  • Ureteroureterostomy
  • Neoureterocystostomy
  • Urinary diversion


What are the advantages/disadvantages of a nephroureterectomy following ureteral trauma?

  • Disadvantage--financial constraints
  • Advantage--minimizes complications


What are the advantages/disadvantages of a ureteroureterostomy following ureteral trauma?

  • (Ureteral anastomosis)
  • Procedure of choice for proximal ureter (can't re-implant)
  • Disadvantages
    • Requires magnification
    • Extremely difficult
    • High incidence of complications
      • Strictures
      • Dehiscence 


What two methods are available for urinary diversion after ureteral surgery?

  • Ureteral stent
    • Double pigtailed catheter
  • Nephrostomy tube
    • Closed system
    • Urine deposited externally


What procedures can be used if you have loss of length of the distal or proximal ureter?

  • Transureteroureterostomy
  • Renal descensus 
  • Nephrocystopexy
  • Psoas hitch
  • Bladder wall flap


What is a transureteroureterostomy and when is it used?

  • Used when proximal ureter length is insufficient to reach the bladder but long enough to cross midline
  • Bring ureter segment across midline and anastomosis to other ureter


What is done during a renal descensus? When is it indicated?

Mobilize the kidney and suture caudally to lumbar musculature

Indicated for inadequate ureter length


What is a nephrocystopexy?

Suturing the kidney to the cranial edge of the bladder



What is a psoas hitch?

Fixing the bladder in a more cranial position (to apaxial muscles)


When/how do you perform a bladder wall flap surgery?

  • Performed when significant loss of distal ureter occurs
  • Elevate bladder flap
  • Implant ureter to end of flap
  • Suture flap in a tube and close defect


What are the clinical signs of ureterolithiasis?

  • Often asymptomatic
  • UTI
  • Hematuria
  • Anorexia
  • Lethargy
  • Pain


How do you diagnose ureterolithiasis?

Rads--most are radiopaque (Ca oxalate)

U/S--also determines dilation of ureter/pelvis


What are the indications for surgery or lithotripsy due to ureterolithiasis?

  • Complete obstruction
  • Azotemia
  • Pyelonephritis
  • After 2 weeks of unsuccessful medical treatment


What are the options for medical management (non-surgical) of ureterolithiasis?

  • Medical dissolution is not an option
    • Most are Ca oxalate
    • Not bathed in urine
  • If asymptomatic: try to diurese into bladder
    • Smooth muscle relaxers
  • IV fluids and diuretics
    • Helps increase flow
    • Serial monitoring for 2 weeks (rads, u/s)


What are the pre-surgical considerations for ureterolithiasis?

  • Cannot predict length of obstruction
    • 1wk = GFR <65%
    • Can't predict how well kidney will recover
  • Most cats have pre-existing interstitial nephritis unrelated to obstruction
  • If azotemic with unilateral obstruction-->has bilateral renal disease
  • High complication rate


What are the surgical treatment options for ureterolithiasis?

  • Cystotomy and retrograde flushing and removal via pyelithotomy
  • Ureterotomy


What are the advantages/disadvantages of ureteral stenting?

  • Advantages
    • Decreased morbidity
    • Shorter hospitalization
    • Fewer complications
  • Disadvantages
    • Specialized equipment
    • Steep learning curve
    • Expensive


What is the non-surgical method of ureteral stenting?

Endoscopic placement

  • Female/male dogs >8g
  • Gen. anesthesia
  • Fluoroscopy, guide wire, urethral catheter
  • Contrast media to visualize pelvis-->ureteral stent aided by pusher catheter


What is the surgical method of ureteral stenting?

  • Dogs
    • Distal cystotomy approach
    • No pusher catheter required
  • Cats
    • Usually placed antegrade


What is the SUB?

  • Locking loop kidney catheter with a marker band at one end and a fenestrated and cuffed bladder at the other end
  • Both ends connect to a shunting port with 2 catheter outlets


How does the SUB unit bypass the ureter?

  • Flow is from the kidney to the shunting port and into the bladder
  • Port has silicone diaphragm