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38 Cards in this Set

  • Front
  • Back
What is the most common surgery of the bladder?
Cystotomy - usually to remove stones
Where is the incision made when performing a cystotomy? Why?
Now on the ventral surface because that's where the ureters open into the trigone so the ureters can be cut, but used to be taught on dorsal surface bc urine pools on the ventral surface
How do you close up a cystotomy?
Either a single or double layer approach, but use appositional suturing when inflamed and thickened
What is the healing rate of the bladder? How much strength does it regain?
Heals incredibly fast and well, can regain 100% of its strength (usually 80% max)
What suture pattern do we use to close up a cystotomy?
Lembert or cushing (inverting sutures)
Why do we prefer a cushing over a connel when closing up a cystotomy?
Try to avoid putting sutures in the lumen like with a connel
Why is absorbable suture ALWAYS used on the bladder?
because the non-absorbable suture has been associated with a risk factor for infection and stone formation bc grabs sutures and allows crystals to grow
Where do the ureters enter the bladder?
Dorsolaterally so watch out for ureters when closing up a cystotomy, don't want to obstruct ureters, why we don't do double layers near ureteral openings
Can the majority of the bladder be removed?
Yes, can remove up to 80% of bladder - do this for transitional cell carcinomas
What animals most commony have urethrotomies performed?
Male dogs since have small narrow, long urethras most likely to get stone lodged
What are the 2 approaches to performing a urethrotomy?
Perineal
Prescrotal
How do you perform a prescrotal urethrotomy?
-just make an incision similar to a castration and extend incision up into the penile urethra and can remove stones
Do prescrotal urethrotomies heal by primary or secondary intention?
Can let them heal by second intention- but expect blood when the dog urinates for a couple of weeks
-Suture mucosa if relatively healthy and can achieve adequate apposition - other wise get large gaps and more likely to create a stricture
How do you perform a perineal urethrotomy? (5)
-Incise dorsal to scrotum and ventral to anus
-Push retractor penis muscle to side
-cut into base of penis down to urethra
-Remove stone
-leave to heal by second intention
Where do stones commonly get lodged in the urethra in males?
Get stuck at caudal aspect of os penis (os penis is an inverted U and the urethra goes through that inverted U so often gets lodged when hits os penis because there's no distension there
Why is it important to leave the urethra as long as possible when performing a urethrostomy?
Important for urinary continence, prevents bacteria from ascending into the bladder so the shorter the urethra the easier it is for an ascending infection** and recurrent UTIs
How do you decide what type of urethrostomy to do?
Where problem is and what's the longest urethra I can leave?
What are the 6 types of urethrostomies that can be performed in a dog?
1) Prepubic
2) Subpubic
3) Trans-ischial
4) Perineal
5) Scrotal
6) Prescrotal
Why would you need to perform a urethrostomy?
Sometimes stones cause so much damage or just keeps recurring and makes a permanent opening in part of urethra that has larger opening to prevent repeat stone formation OR tumor of urethra
What is a prepubic urethrostomy?
It is closest to the bladder, leaves the least amount of urethra out of the different types of urethrostomy, urethra is coming out of a little hole in the abdomen.
How do you perform a prepubic urethrostomy?
Cut a little hole in the abdominal wall and suture epithelium of abdominal wall to epithelium of the urethra =permanent hold
What is a subpubic urethrostomy?
Make hole in pubic bone itself or sometimes come through the obturator foramen- so make urethra come through there, go through skin and then that’s where you urinate
What is a trans-ischial urethrostomy?
take ischium and take a burr powered instrumen and remove part of symphis where right and left ischium meet together and make hole and put urethra through hole to skin
What is a perineal urethrostomy?
like perineal urethrotomy , then take mucosa of urethra and sew into skin
What is a prescrotal urethrostomy?
just like castration where incision is cranial to scrotum keep going down to penis and then suture mucosa to skin
What is a scrotal urethrostomy?
remove the scortum (scrotal ablation) and that’s where you suture the mucosa to skin; in b/w perineal and prescrotal
What are the 4 types of urethrstomies that can be performed in cats?
1) Prepubic
2) Subpubic
3) Trans-ischial
4) Perineal: by far most common
-can't do others because the penis is ventral to anus
Why are perineal urethrostomies the most common in cats?
Because it removes the narrowest part of the penile urethra and leaves the largest amount of urethra.
What should you be the first thing you should do when a male cat comes in that's emergency because of a blocked urethra?
Stabilize the cat first!
It is really important to do what when preparing to perform a urethrostomy in a cat?
empty the bladder so do cystocentesis and decompress bladder best you can before surgery, bc until kidney can create more urine electrolyte abnormalities will not be corrected until produces more urine.
What is the first step in performing a perineal urethrostomy in a cat?
-remove scrotum and prepuce, cut along perineal area and identify where urethra is, put a catheter into the penis so know exactly where urethra is, need to be very careful finding urethra
What do you do after doing the scrotal ablation and identifying the urethra when performing a perineal urethrostomy in a cat?
-Want to cut ischiocavernosus muscle and ischiourethral m. and want to cut them on either side because allows you to pull urethra caudally, want to get into the big diameter of urethra which is more cranial, little blood vessel that bleeds when cut these muscles
What do you do after cutting the ischiocavernosus and ischiourethral muscles during a perineal urethrostomy in a cat?
-pull out urethra and cut dorsal surface of urethra (open it up) and guideline is to go all the way to the bulbourethral gland (where urethra becomes very wide) and key is to go all the way there! If haven’t gone cranial enough then cat is at risk of obstructing again- go all the way to gland!
What do you do after cutting open the dorsal surface of the urethra all the way to the bulbourethral gland during a perineal urethrostomy in a cat?
Cut into the penis and make sure to leave enough urethra to form a draining board
What is the draining board made during a perineal urethrostomy on a cat? Why is it very important?
use urethra that’s opened up and place it ventrally so when cat pees there’s a draining board of urinary epithelium- if just skin then skin is very sensitive to urine and get urine scalding, so when bring urethra ventrally and suture it here so when pee dribbles it dribbles on uroepithelium (can withstand burning of urine)
How do you suture the urethra when performing a perineal urethrostomy on a cat?
So have hole in urethra an dput suture at eleven o’clock and one o’clock to pull it out and make it wide and big and suture all the way down and around the draining board and make sure sutured very well
What is the most common complication in perineal urethrostomies in a cat?
stricture or dehiscence and then urethra starts pulling cranially again and then urine goes into SQ= bad, urine pooling in SQ→ area that causes necrosis of skin and muscle and then urea is reabsorbed etc= very sick
What is a good way to practice perineal urethrostomies?
On cadavers