urinary surgery

Question 1

urinary anatomy

Answer 1

Question 2

renal abscess
C/S, dx, tx

Answer 2

rare, associated w pyelonephritis, nephroliths, DM, cushings

dx- U/S and CT, cytology of fluid, culture
tx- supportive care, abx, stent/sub, nephrectomy

Question 3

renal trauma

Answer 3

hx, hematuria, pain on palpation, hemoabdomen, uroabdomen

dx- U/S, CT, excretory urography, ex lap
tx- suture laceration, nephrectomy

Question 4

renal neoplasia types, C/S, dx

Answer 4

metastatic disease
dogs- renal carcinoma, TCC, hemangiosarc, lymphoma
nephroblastoma- young dog
cats- lymphoma, carcinoma

C/S- hematuria, weight loss, lethargy, UTI, abd mass
dx- UA, isosthenuria, nodules, AXR, CT, aspirate

Question 5

ureter trauma C/S, dx, tx

Answer 5

vague C/S- lethargy, anorexia, pain, v+
dx- enlarged retroperitoneal space on rads, abd U/S/CT for fluid, excretory urography

tx- primary repair w stent, reimplantation, ureteronephrectomy, sub, postop cath

Question 6

ureter neoplasia

Answer 6

TCC from bladder
C/S- pain from bladder mass
tx- ureteronephrectomy, stent, chemo/RT
lymphoma- chemo
metastatic- chemo, palliative

Question 7

bladder trauma

Answer 7

HBC, fall, penetrating wounds
urine leakage-> azotemia, dehydration, hypovolemia
dx- abd fluid CRE to blood, AXR w contrast
tx- medical stabilization, surgery to close w appositional patternb

Question 8

bladder herniation

Answer 8

trauma (HBC), perineal hernia, iatrogenic
reposition and cystopexy, repair defect

prepubic tendon rupture, retroflexion

Question 9

persistent urachus

Answer 9

ventral ligament of bladder remains patent-> urine leakage from umbilicus, can act as nidus for UTI
dx- recurrent UTI, leakage, rads w contrast
tx- resect remnant

Question 10

bladder neoplasia

Answer 10

malignant TCC, SCC,carcinoma
benign masses- fibroma, papilloma
polypoid cystitis
dx- high renal values, UA, abd U/S, CT, biopsy, cystoscopy

tx- partial cystectomy, check LN
chemo- NSAIDs

Question 11

urethral trauma C/S, dx, tx

Answer 11

partial/complete tear-> trauma, pubic fx, wounds
C/S- uroperitoneum (proximal), cellulitis (distal)
dx- retrograde contrast cystourethrogram
tx- surgical, cystotomy/ucath-> heals in 5-7d

Question 12

urethral prolapse

Answer 12

young intact male dogs
C/S- bleeding from tip of penis, licking
tx- tx infection, neuter
reduction-> purse string 5d, R/A, urethropexy

Question 13

urethral neoplasia

Answer 13

older female dogs, TCC, SCC TVT
C/S- hematuria, stranguris, dysuria, PU
dx- rectal, urethrography, cystography
tx- medical, stent/amputation, RT/chemo

Question 14

urolithiasis C/S, dx, tx

Answer 14

C/S- hematuria, stranguria
male dogs can obstruct-> abd pain, v+, depression
dx- azotemia, rads, CT, contrast cystourethrogram

tx- retrohydropulsion, surgical removal of stones
- cystotomy
- urethrotomy
urethrostomy

Question 15

cystotomy

Answer 15

clip/drape in vulva/prepuce, caudal midline incision, isolate bladder
stay sutures in apex of bladder-> incision on ventral surface
take sm piece of bladder for culture

remove stones-> flush urethra several times
close w one layer 3-0/4-0 PDS simple cont. monocryl
submit stone, post op rad

Question 16

urethrotomy

Answer 16

incision over stone on midline-> heals in 7-10d
close w 4-0/5-0 absorbable

Question 17

urethrostomy

Answer 17

permanent hole in urethra
recurrent FLUTD, stricture, recurrent uroliths, neoplasia

dogs: scrotal urethrostomy-> neuter
cats: perineal, incised to level of bulbourethral glands-> suture to skin w 4-0/5-0 mono suture

complications: stricture, hematuria, recurrent UTI, incontinence, perineal hernia

Question 18

ureteronephrectomy

Answer 18

referral sx
ventral midline incision-> dissect affected kidney and flip medially-> isolate renal artery, vein, ureter (transect artery first), remove all of ureter