Describe the vascular supply to the bladder.
- cranial vesical artery
- caudal vesical artery
- comes through the lateral ligaments of the bladder
What is contained in the lateral ligaments of the bladder? (4)
- caudal vesicular artery and vein
- branches of hypogastric and pudendal nerves
What is the parasympathetic supply to the bladder, controlling micturition? What are the functions?
- pelvic nerve- detrusor muscle contraction--> bladder emptying
- [triggers by distention of stretch fibers]
What is the sympathetic supply to the bladder, controlling micturition? What are the functions?
hypogastric nerve- detrusor muscle relaxation and urethral smooth muscle contraction--> urine retention
What is the surgical holding layer of the bladder?
The bladder regains _______ of original strength by _________ post-surgery.
100%; 28 days
What suture do you use to close the bladder?
- synthetic monofilament- Polydioxinone, Polyglyconate, 4-0
- minimize exposure of sutures to bladder/ urethral lumen
What organisms are frequently associated with UTIs in dogs? (6)
- E. coli
- Pseudomonas (rare)
What are host mechanisms of defense against bladder infections?
- high pressure micturition (flushing urethra)
- anatomy- long urethra, high pressure zones, urothelium, commensal microbes
- mucosal defense- local immunity, surface glycosaminoglycans, exfoliation
- antimicrobial properties of urine- urine pH, hyperosmolality, urea
Describe characteristics of UPEC.
uropathogenic E. coli- P pili promote attachment to urothelium--> forms biofilm-like intracellular bacterial community (antibiotic resistant zone)
What is the usual inciting cause of struvite urolithiasis?
- urease-producing bacteria infection of the bladder
- Staph or Proteus
- hydrolysis of urea--> production of ammonium and carbon dioxide--> progressive alkalinity--> struvite (magnesium ammonium phosphate)
Struvite stones form in a(n) _________ environment.
What are indications for cystotomy? (4 categories + specific)
- urolithiasis***: cystoliths, ureteroliths, urethroliths
- trauma: ruptured bladder, rupture/ avulsion of ureter, urethral rupture, urine leakage into abdomen, hematoma
- congenital disorders: patent urachus/ diverticulum, ureteral ectopia, ureterocele, pelvic bladder syndrome
- inflammatory disorders: infection, polyploid cystitis, emphysematous cystitis, hemorrhage (idiopathic renal hematuria)
What are the radiolucent calculi? (3) How do you diagnose them if you have high suspicion?
- double contrast cystogram the most accurate method to dx
Where do you place stay sutures during bladder surgery?
1 at apex, 1 on either lateral side of bladder incision
What is an important aspect of cystomoty for uroliths in male dogs and cats?
you MUST retrograde flush the urethra before close the bladder to ensure all stones have been removed
How do you close a cystotomy incision?
1 or 2 layers, simple continuous, cushings (only SIGHTLY inverting please), maybe lembert
What is an important post-operative task after removing stones?
if they were radiodense, RE-RADIOGRAPH the patient! make sure they were all removed
What are potential benign mass lesions of the bladder? (2)
What are potential malignant mass lesions of the bladder? (4)
- if epithelial- TCC
- if mesenchymal- leiomyosarcoma, rhabdomyosarcoma, hemangiosarcoma
What is polyploid cystitis? What causes it?
- inflammatory polyploid proliferations arising from the bladder mucosa and submucosa
- results from chronic infection or inflammation
What is the treatment of polyploid cystitis?
surgical removal/ "stripping" of the mucosal lining of the bladder [mucosa and submucosa are well-defined]
What is the typical location of TCC?
trigone of the bladder--> obstruction to urine outflow
What are common locations for TCC to metastasize to? (4)
- lymph noes
- seeds needle tracts and incisions
How do you confirm diagnosis of TCC?
- need biopsy! endoscopic biopsy ideal
- we really try not to cysto or percutaneous needle biopsy if you think there’s a mass lesion in the bladder of a dog (very commonly TCC, which will seed); how do we biopsy? if you don’t have an endoscope, place a red rubber catheter and do a traumatic biopsy
What are treatment dilemmas for TCC?
- location precludes complete resection
- translocation and seeding of tumor at incision and into abdomen
- surgical debulking may or may not be beneficial; consider placement of cystotomy catheter or urethral stent