Urinary tract SX

Question 1

What is the unidirectional flow of urine:

Answer 1

kidney-pelvis- ureter- ureterovesicular junction- bladder- urethra- os/ opening

Question 2

Bladder:

• Blood supply
• Nerves
• Ligaments

Answer 2

 Blood supply: Cd vesicular a. (some animals may also have a cr counterpart)
 Nerves: Pudendal n. (somatic), hypogastric n. (sym), pelvis n. (para)
 Ligaments: Lat ligaments, ventral ligament

Question 3

What bladder ligament should you not transect & why?

Answer 3

Lateral ligament

location of blood supply, ureter & nerves

Question 4

What bladder surface should be cut during a cystotomy?

Answer 4

Cut into ventral surface, NOT dorsal surface bc ureters and ductus deferens insert dorsally at trigone

Question 5

What is the holding layer for the bladder?

Answer 5

Submucosa is the holding layer

Question 6

Why aren’t nephrotomys performed often?

Answer 6

remove kidney stones, but it causes a loss of function.

Question 7

What does a nephrostomy tube do?

Answer 7

reroute urine to bypass ureter

Question 8

What is a subcutaneous ureteral bypass?

Answer 8

salvage technique that is a permanent ureter bypass

Question 9

What procedure is done to reinsert ureter into bladder (i.e. ectopic ureter)?

Answer 9

neoureterostomy

Question 10

What surgical approach is taken for bladder or urethra surgery?

Answer 10

Caudal midline celiotomy

Question 11

What is a cystostomy?

Answer 11

Diversion of urine to bypass urethra. ( done if cant be unobstructed)

Question 12

How much of the bladder can be removed in a cystoectomy?

Answer 12

60-75%

Question 13

Why is a cystotomy preferred over a urethrotomy?

Answer 13

Incisions are easier- less prone to strictures

Question 14

When is a urethrostomy indicated?

Answer 14

When stone formation cant be prevented

• remeber close skin to urethral mucosa and to make the site big!

Question 15

What type of urethrostomy occurs in dog?

Answer 15

Prescrotal +/- penile amputation

• SU

Question 16

What type of urethrostomy occurs in cats?

Answer 16

Perineal + penile amputation

• PU

Question 17

Urethral prolapse sx

Answer 17

Urethropexy

Question 18

How do you prevent urine contamination with cystotomy?

Answer 18

Make sure to use lap sponges to prevent urine contamination.

Stay sutures at apex of bladder and either side of the incision.

Question 19

What does dilution is the solution to pollution mean?

Answer 19

Lavage using saline

• no additive because chemicals can cause further inflammation
• 50-100 mL/kg
• suctioned until fluid clear

Question 20

Preferred drainage method is:

Answer 20

Either open or closed, but closed involves Jackson pratt or active suction

Question 21

What are the benefits to feeding patient vs fasting- post op?

Answer 21

Improves incisional healing and decreases hospital stay

Question 22

Feeding tube options

Answer 22

NG tube ( 2-3 days)
esophageal (3-4wk)
Gastrotomy (2 mo- placed on left side/ fundus)