Surgical Diseases of the Urinary Tract

Question 1

What should initial investigation of a suspected urinary tract disease involve?

Answer 1

Bloods
Urinalysis
Radiography/IV urography
Ultrasonography

Question 2

What can be seen via ultrasonography?

Answer 2

Structure and definition of kidneys/ureters/bladder/urethra

Uroliths, masses, lesions, inflammatory disorders, prostatic diseases

Ectopic diseases

Question 3

How can you lessen the potential for wound contamination/infection during urinary surgery?

Answer 3

Use antibiotic cover (especially in presence of known UTI)

Minimise spillage of urine with laparotomy swabs packed around bladder

Question 4

What surgical equipment is useful in urinary surgery?

Answer 4

Fine instruments and suture material 
Abdominal retractors 
Tubes for cystotomy 
Urethral catheters 
Suction 
Spoons for bladder stones 
Magnification

Question 5

What are some common surgical diseases of the kidneys?

Answer 5

Neoplasia
Trauma
Renoliths (renal stones)
Diseases secondary to ureteric disease

Question 6

What type of tumour is the most common in dogs?

Answer 6

Carcinoma

Question 7

What are the clinical signs of renal neoplasia?

Answer 7

Haematuria

Palpable abdominal mass

Question 8

What is the most common renal tumour in cats?

Answer 8

Lymphoma

Question 9

Why is surgery not often recommended for renal stones?

Answer 9

They are often seen in animals with concurrent chronic renal failure

Question 10

What is the common treatment for renal stones?

Answer 10

Many can be dissolved with diet and antibiotic therapy

Question 11

What is a nephrotomy?

Answer 11

Incision through the body of the kidney

Question 12

When might a subcutaneous ureteral bypass be required?

Answer 12

In patients with a blocked ureter (calcium oxalate stones) which cannot be medically dissolved

Question 13

What are some causes of kidney disease secondary to ureteric disease?

Answer 13

Ureters undergo trauma during spay surgery

Ureteral obstruction can be managed by nephrectomy

Question 14

What is a nephrectomy?

Answer 14

Surgical removal of a kidney

Question 15

Why might a nephrectomy be required?

Answer 15

Renal neoplasia or trauma
Chronic pyelonephritis
Idiopathic haematuria

Question 16

Why is it important to blood type a patient prior to nephrectomy?

Answer 16

Potential for severe haemorrhage

Question 17

What is ureteral ectopia?

Answer 17

Congenital anomaly in dogs resulting in ureters opening into urethra instead of bladder

Question 18

What is the surgical treatment for ureteral ectopia?

Answer 18

Neo-ureterostomy

Question 19

How successful is neo-ureterostomy surgery?

Answer 19

50% of affected remain incontinent due to congenital urethral sphincter incontinence

Question 20

What are the common surgical diseases of the bladder?

Answer 20

Uroliths
Neoplasia
Trauma

Question 21

What is the most common type of urolith in UK?

Answer 21

Struvite

Question 22

Which types of uroliths are amenable to medical dissolution?

Answer 22

Struvite and urate uroliths

Question 23

How are uroliths causing obstruction/severe clinical signs removed?

Answer 23

Via surgery - cystotomy

Question 24

What signs do bladder stone patients present with?

Answer 24

Haematuria
Frequency/urgency to urinate
Complete obstruction (severe - emergency)

Question 25

What signs do bladder neoplasia patients present with?

Answer 25

Haematuria Frequency/urgency to urinate Complete obstruction (severe - emergency)

Question 26

In what location can bladder neoplasia not be excised?

Answer 26

If affecting the trigone/bladder neck

Question 27

What is the consequence of bladder trauma/rupture?

Answer 27

Uroabdomen | Post-renal failure

Question 28

What is the treatment for bladder trauma/rupture?

Answer 28

IVFT to stabilise patient | Surgical repair or indwelling catheter may allow healing

Question 29

When might a cystotomy be performed?

Answer 29

For visualisation and removal of bladder stones

Question 30

What should happen to stones removed during cystotomy?

Answer 30

Submit for lab analysis for composition and culture and sensitivity

Question 31

What observations should be done post-op for cystotomy?

Answer 31

Observe for absence of urination or abdominal distension | Ensure plenty of opportunities for urination

Question 32

What are the most common urethral stones in UK?

Answer 32

Struvite (mostly males due to anatomy)

Question 33

What should be involved in management of urethral stones?

Answer 33

Restore circulating volume, reduce hyperkalaemia and relieve obstruction

Question 34

How should urethral obstructions be relieved?

Answer 34

Empty bladder by cystocentesis Careful urethral catheterisation If unsuccessful, attempt retrograde flushing with sterile saline and then remove via cystotomy

Question 35

What is a USMI?

Answer 35

Urethral sphincter mechanism incontinence

Question 36

How can USMI be medically managed?

Answer 36

Oestrogen or phenylopropanolamine

Question 37

How else can USMI be treated if it does not respond to medication?

Answer 37

Surgically - Colposuspension Urethropexy Hydraulic artificial urethral sphincters

Question 38

What is colposuspension?

Answer 38

Treatment of USMI - moving bladder neck and proximal urethra to an intra-abdominal position to lengthen urethra

Question 39

What is urethropexy?

Answer 39

Treatment of USMI - increases pull and tone of urethral muscles, by using sutures to stretch out the urinary tract and increase the force required to urinate

Question 40

What is FLUTD?

Answer 40

Feline lower urinary tract disease

Question 41

When is FLUTD considered a surgical disease?

Answer 41

When males suffer repeated episodes of urethral obstruction

Question 42

Which cats are most prone to FLUTD?

Answer 42

Overweight, neutered, middle age, indoor cats, with dry diet

Question 43

What are some of the causes of FLUTD?

Answer 43

Bacterial infection Urethral spasming FIC Neoplasia Blockages by stones/plug

Question 44

What is the most common form of urethral neoplasia?

Answer 44

Transitional cell carcinoma

Question 45

What is the most common form of urethral neoplasia?

Answer 45

Transitional cell carcinoma

Question 46

What is the treatment for urethral neoplasia?

Answer 46

Too advanced for surgical excision By-passing the urethra may provide palliation (urethral stents, tube cystotomy)

Question 47

What is a urethrotomy?

Answer 47

Incision into the urethra

Question 48

What is a urethrostomy?

Answer 48

Creation of a permanent new opening

Question 49

What types of urethrostomy are commonly performed in the dog and cat?

Answer 49

Scrotal urethrostomy in dog | Perineal urethrostomy in cat

Question 50

Why might a tube cystotomy be performed?

Answer 50

Used as a urinary diversion technique | Diverting urine away from urethral surgical sites/neoplasia/detrusor atony

Question 51

What considerations should be taken after urethral surgery?

Answer 51

Absolute prevention of patient interference Haematuria, but should resolve within a few days Care with litter (shredded newspaper) Observe for dysuria Keep an eye on post-op BP Pain relief (opioids)

Question 52

What are the possible causes of prostatic disease in dogs?

Answer 52

``` Benign hyperplasia Protastitis Abscessation Cysts Neoplasia ```

Question 53

What is benign prostatic hyperplasia?

Answer 53

Non-cancerous increase in prostate size

Question 54

How is benign prostatic hyperplasia managed?

Answer 54

Castration if entire | Anti-androgens

Question 55

What is prostatitis?

Answer 55

Inflammation of the prostatic gland (bacterial infection?)

Question 56

What are the symptoms of prostatitis?

Answer 56

Dysuria, pyrexia, | purulent penile discharge

Question 57

How is prostatitis managed?

Answer 57

Antibiotics and Tardak (anti-androgens) | Castration if entire

Question 58

What are the symptoms of a prostatic abscess?

Answer 58

Usually with prostatitis (entire males) dysuria/dyschezia

Question 59

How can prostatic abscesses be treated?

Answer 59

Castration | Omentalisation following re-roofing and flushing of the abscess

Question 60

What can result if a prostatic abscess bursts?

Answer 60

Septic peritonitis (emergency)

Question 61

What causes a prostatic cyst?

Answer 61

Prostatic ducts get blocked leading to a buildup of fluid, leading to cysts (entire males)

Question 62

How are prostatic cysts treated?

Answer 62

Castration | De-roof and omentalisation

Question 63

What is the prognosis for prostatic neoplasia? How can animals be palliated?

Answer 63

Poor | Can be palliated with urethral stents (if unable to urinate)

Question 64

How should urethral obstructions be relieved?

Answer 64

Empty bladder by cystocentesis Careful urethral catheterisation If unsuccessful, attempt retrograde flushing with sterile saline and then remove via cystotomy