Urinary Tract 2

Question 1

For a uroabdomen:

1. State the cause
2. How they should be diagnosed
3. Discuss the urgency of the surgery and the surgical options

Answer 1

1. Trauma to the bladder, ureter (build up of fluid in the retro-peritoneal space) or urethra
2. Diagnosis: need CT and contrast radiography to work out where it is comming from. On abdominocentesis increased creatinine + K for diagnosis (urea rapidly equilibriates)
3. Surgery is a medical emergency but delay the surgery until the animal is stable. Reduce K (Dextrose and Insulin), reduce cardiotoxicity (calcium gluconate). Bladder can be fixed with simple interupted appositional closure (others need more complicated and depend on site). Place a peritoneal catheter

Question 2

For urethral sphincter mechanism incompetence:

1. Explain the two causes it
2. Describe the mechanisms for managing it medically
3. Describe the mechanisms for managing it surgically

Answer 2

Two main mechanisms - congenital or acquired:

• Congenital - usually resolves after the first heat
• Acquired - in speyed bitches

Mechanisms:

• Contraction of the urethra occurs by a receptor agonism

a-Adrenergic agonist:

• Phenylpropanolamine
• Pseudoephedrine

Increased smooth muscle sensitivity to a-adrenergic stimulation:

• Oestrogen

Surgical technique:

1. Colposuspension - vagina is pexied to the prepubic tendon ⇒ brings bladder cranially ⇒ more urethra in abdomen
2. Urethropexy - suture the urethra to the prepubic tendon
3. Urethral submucosal injections - insert teflon into proximal urethral submucosa
4. Artificial hydraloric sphincter - inject saline until continence stops

Question 3

For ectopic ureters:

1. What are the two different types and what species do they occur in most commonly?
2. What are some concurrent findings that may be seen?
3. How they can be diagnosed
4. The surgical options available for their treatment
5. What is the prognosis for them?

Answer 3

Two different types:

• Intramural (most dogs)
• Extramural (more cats)

Concurrent findings:

• Hydronephrosis
• Hydroureter
• Pyelonephritis

Diagnosis:

• Always been incontinent and normally wet through their bed

Surgical options:

• Neoureterostomy – new opening
• Uteroneocystomy – ureteral re-implantation
• Laser guided ablation
• Nephroureterectomy – remove kidney and ureter

Prognosis:

• Normally these conditions have a poor prognosis - tend to recurr

Question 4

For urethral prolapse:

1. State the cause
2. Describe the medical managment
3. Describe the surgical treatment of them

Answer 4

Cause:

• Excitement + urinary infection

Medical management:

• Massage ⇒ reduce ⇒ purse string

Surgical treatment:

• Resection of redundant mucosa + anastomosis to penile mucosa
• Good prognosis w/surgical resection

Question 5

Why is the prognosis for ectopic ureters generally quite poor and what other treatment options can be considered?

Answer 5

Poor prognosis:

• Generally concurrent USMI
• Recanalisation of the ureter

Ongoing medications:

• Phenylpropanolamine
• Oestrogen

Question 6

How should a renal biopsy be taken?

Answer 6

• Should be taken tangentially to the surface to sample cortex

Question 7

What is the most common type of bladder neoplasia? - describe the behaviour of it

Answer 7

Transitional cell carcinoma - quite malignant - metastasise in 6-9 months

Question 8

What are the implications of a wound that appears like this?

Answer 8

Slough/eschar formation ⇒ impedes wound healing