IntroSx2- Urinary Tract Sx

  1. What are the keys to success in urogenital surgery? (7)
    • maintain surgical asepsis
    • know regional anatomy
    • gentle soft tissue handling
    • adequate hemostasis
    • maintain lumenal diameters
    • avoid tension
    • appropriate suture choices
  2. What muscles o you cut when using a ventral paramedian approach to the abdomen?
    external oblique, internal oblique, transversus abdominis
  3. Upper urinary tract lies within the _____________; the bladder is located...
    retroperitoneal space (kidneys, ureters); ventral to the colon within the peritoneal cavity
  4. What does the flank approach facilitate exposure of? (4)
    [dorsally located structures] kidney, ovary, adrenal, lymphatics
  5. What body wall layers do you incise with the flank approach?
    external oblique, internal oblique, transversus abdominis
  6. How do you close the body wall on a flank approach to the abdomen?
    three separate muscle layers sutured individually (b/c less holding strength than external rectus fascia)
  7. What sutures do you avoid in urinary surgery? (4)
    • avoid non-absorbable
    • avoid prolonged absorbable (stays around too long and can lead to stone formation)
    • avoid multifilament (too much capillarity, can lead to infection)
    • avoid sutures that are too large (scale down size if possible)
  8. What is the best type of suture to use in urinary surgery, ESPECIALLY if you must leave intraluminal sutures?
    • synthetic monofilament that is rapidly absorbable (bladder heals fast and strong)
    • Monocryl good option
  9. What unique instruments are used in renal biopsy procedures? (2)
    Franklin-Silverman, True-Cut
  10. What locations in the kidney have the highest concentrations of nephrons (therefore the sites we want to biopsy)?
    renal cortex, corticomedullary junction
  11. How do you position your biopsy needle for renal biopsy?
    • position needle along the long axis, parallel to length of kidney
    • DO NOT point needle toward the renal pelvis/ hilar region (you will cause a lot of bleeding)
  12. What surgical techniques are used for renal biopsy? (2)
    • "Key hole": make small incision, slide finger in, and palpate for renal artery and vein, then can direct biopsy needle away from vasculature
    • Open celiotomy: visualize both kidneys, needle or wedge biopsy, control bleeding better
  13. What are complications associated with renal biopsy? (3)
    • hemorrhage: hematuria, subcapsular hematoma, hemoabdomen
    • laceration of renal pelvis: uroabdomen
    • insufficient biopsy sample: lack of nephrons
  14. What is a nephrotomy and what is the indication?
    surgical incision through the renal parenchyma, exposing the renal pelvis to remove a nephrolith or other obstructive lesion
  15. Describe the relevant renal anatomy that is of important in nephrotomy.
    renal artery enters at hilus then divides into dorsal and ventral branches; therefore, we make a nephrotomy incision along the greater curvature to avoid major vessels
  16. Describe major techniques used in nephrotomy. (6)
    • tourniquet applied to renal vascular pedicle (minimize tourniquet time to 3-5min)
    • incise along greater curvature
    • expose renal pelvis
    • remove obstruction
    • flush renal pelvis and ureter
    • biopsy kidney and get aerobic culture
  17. How do you close a nephrotomy incision in he kidney?
    simple continuous suture capsule with 3-0 to 4-0 chromic gut
  18. What are potential complications with nephrotomy? (3)
    • hemorrhage
    • renal parenchymal injury (hypoxia from tourniquet or surgical trauma)--> renal failure
    • failure to completely remove obstruction
  19. Describe techniques for opening the animal up for nephrotomy.
    you must pick kidney up out of the retroperitoneal space; therefore, use flank approach or if you use ventral midline approach, you must open the retroperitoneal cavity into the abdomen
  20. What are indications for bladder surgery? (5)
    • urolithiasis
    • trauma
    • congenital abnormalities
    • biopsy/ culture
    • evaluation of upper tract
  21. What are the contents of the lateral ligament of the bladder? (4)
    • ureters, cranial vesicular artery and vein, branches of hypogastric and pudendal nerves
    • [lots of important structures!!! know where the ligaments are and protect them!]
  22. What is the surgical holding layer of the bladder?
  23. The bladder regains ________ of its presurgical strength by ________ post-surgery.
    100%; 28 days
  24. Describe how you open the bladder. What are the advantages of this approach? (3)
    • cut down the ventral surface of the bladder (opposite the entrance of the ureters)
    • this exposes the trigone and bladder neck, permits evaluation of ureteral orifices, avoids injury to lateral ligaments
  25. What samples MUST we collect when performing cystotomy? (4)
    • aerobic bacterial culture of urine AND bladder mucosa
    • bladder wall biopsy
    • stone analysis (if stones)
  26. Describe closure of cystotomy (pattern, suture type).
    • create a water-tight seal with 1 or 2 layers, cushing is best (lembert second option)
    • Monocryl or PDS (only PDS if partial thickness closure)
  27. ___________ is the most common site of lower urinary tract obstruction in __(2)__.
    Urethra; male dogs and cats
  28. What are common etiologies of LUT obstruction? (7)
    • urolithiasis¬†(most common in male dogs)
    • congenital or acquired stricture
    • trauma
    • neoplasia
    • inflammatory/ infiltrative disease
    • FB/ blood clot
    • iatrogenic (post-sx)
  29. What is the most common location for LUT obstruction in male dogs?
    base of the os penis
Card Set
IntroSx2- Urinary Tract Sx
vetmed IntroSx2