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57 Cards in this Set
- Front
- Back
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What do you call a surgery that cuts into the kidney?
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A nephrotomy
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What is the most common indication for performing a nephrotomy?
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Removal of uroliths (nephroliths)
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What is it really important to differentiate a nephrolith from before performing a nephrotomy?
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Dystrophic mineralization of the pelvis - have to do ultrasound to distinguish
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What stones are radioluscent? Radiopaque?
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-I can't see you: Cysteine and urate stones are radioluscent
-Triple phosphate, struvites, oxalates and urates are radiopaque |
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What do you call a surgery that cuts into the kidney?
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A nephrotomy
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How much does a nephrotomy affect the GFR?
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Decreases GFR by 25 to 50%
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What is the most common indication for performing a nephrotomy?
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Removal of uroliths (nephroliths)
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What is it really important to differentiate a nephrolith from before performing a nephrotomy?
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Dystrophic mineralization of the pelvis - have to do ultrasound to distinguish
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What stones are radioluscent? Radiopaque?
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-I can't see you: Cysteine and urate stones are radioluscent
-Triple phosphate, struvites, oxalates and urates are radiopaque |
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How much does a nephrotomy affect the GFR?
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Decreases GFR by 25 to 50%
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How can you prevent acute renal failure when performing a bilateral nephrotomy?
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Stage it so the one kidney with the injury and insult can recover before doing the other kidney
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What percent of nephrons has to be lost in a kidney before it can no longer concentrate the urine? When do animals become azotemic?
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-66% loss of nephrons= can't concentrate urine
-75%=become azotemic *So don't know based on blood work until hit 75% loss -if lose 50% of GFR from nephrotomy and already has lost 30% then animal could be in serious trouble |
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What diagnostic technique can be used to determine the % of functioning nephrons?
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Nuclear scintigraphy
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What are the first two steps of a nephrotomy once in the abdominal cavity?
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-Free the kidney from retroperitoneal space (break down peritoneum that covers the kidney and bring it up)
-Temporarily occlude vessels (vascular forceps, tourniquet, assistant's fingers) |
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Where do you make the incision on the kidney when performing a nephrotomy?
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Make sharp incision in capsule on lateral convex surface
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What do you do after making the incision into the capsule of the kidney during a nephrotomy?
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Penetrate cortical parenchyma into pelvis
-using a sharp blade and incising OR -blunt dissection w/ a forcep |
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What do you do after penetrating the cortical parenchyma into the renal pelvis when performing a nephrotomy?
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Remove calculi, culture renal pelvi, assess patency of ureter w/ catheter, flush kidney
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How to you close up the kidney once you are done with a nephrotomy?
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-Hold the kidney closed for 5 minutes and its long enough for the fibrin to develop and hold it together= suture-less closure OR
-Suture up the capsule- NOT parenchyma bc has no holding power (fine suture, simple continuous & horizontal mattress) |
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What do you have to do after closing up the kidney after a nephrotomy?
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Fix kidney to abdominal wall to prevent torsion
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What do you call the surgery where you cut into the very bottom part of the renal pelvis and beginning of ureter to retrieve a stone?
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Pyelolithotomy: can't access pelvis (nephrotomy), less damage to kidney
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What do you call removal of a kidney?
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Nephrectomy
-really its a nephroureterectomy bc remove ureter too |
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Why do we remove the ureters too when we remove a kidney?
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Want to ligate the ureters close to the kidney otherwise the ureters will accumulate urine= bacteria party
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What do you have to make sure to preserve in an intact dog when performing a nephrectomy?
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LEFT ovarian or testicular vein drain into the renal vein= preserve
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What do you have to remember when performing ligation during a nephrectomy?
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Avoid ligating renal artery and vein together
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What is a reason to NOT ligate the renal artery and vein together when performing a nephrectomy?
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Not as secure
-if vessels start moving then can slip & loosen--> arterial-venous fistula |
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What is the first step of performing a nephrotomy once in the abdominal cavity?
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Remove the peritoneum on the kidney and free from peritoneal space
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Where are the renal artery and veins in relation to the ureter? How do you approach ligating the renal artery and vein after freeing the kidney from the retroperitoneal space when performing a nephrotomy?
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Dorsal to ureter
-use ventral midline approach so see ureter sitting on top of artery and vein so flip over so can do artery and vein first w/ double ligation |
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What do you do after ligating the renal artery and vein when performing a nephrectomy?
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Pull ureter out and ligate as close to the bladder as possible
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What do you have to make sure to do when ligating the renal artery and vein during a nephrotomy?
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Ligate closest to the bladder first and then do second ligature more cranial because at this point the blood is coming from direction of bladder
-same idea w/ ureter, urine will be coming from bladder at this point |
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Why are ureterotomies so difficult in a cat?
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Has the smallest ureter proportion to body weight of all mammals
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Where do you make your incision when performing a ureterotomy?
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Right over the stone (usually a dilation)
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What suture pattern do you use when you close up a ureterotomy? What type of suture?
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Simple continuous or interrupted
-In urinary system ALWAYS use absorbable bc non-absorbable has greater risk for infection, use monofilament to decrease infection chances |
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What type of suture do you always use if its going to be contacting urine?
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Monofilament absorbable
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What size of suture do you use to close up a ureterotomy
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Dog: 5-0 to 3-0
Cat: 5-0 or 4-0 |
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How do you prevent a stricture from forming when performing a ureterectomy anastomosis?
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Cut ureter at an angle and can spatulate (make longitudinal incision in ureter that gets lumen to be bigger)
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What side of the ureter do you want to spatulate?
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The side opposite of the blood vessel otherwise will get necrosis
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After cutting a ureter on an angle and spatulating the side opposite the blood vessel, what do you have to do to complete the anatomosis for your ureterectomy?
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Have to twist the ends 180 degrees and match them up and suture closed with a simple continuous pattern
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What do you call the surgical procedure performed when there is a blockage at the very caudal end of the ureter that the ureter has to be reimplanted in the bladder?
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Ureteroneocystostomy
-caudal part of ureter is excised -e.g. tumor in caudal ureter so remove part of ureter w/ tumor all the way to bladder and then reattach ureter to bladder |
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What are 2 ways that you can alleviate tension on a uteroneocystostomy (due to a lack of ureter)?
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1) Renal descensus
-manipulate kidney and push it caudally and pexy it caudally 2) Psoas cystopexy -Can stretch bladder closer to kidney and pexy bladder to psoas muscle |
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What can be done in cats when an extreme amount of ureter has been removed during a ureteroneocystostomy?
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Nephrocystopexy: pexy apex of bladder to caudal pole of kidney
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What is the preferred method for reattaching the ureter to the bladder during a ureteroneocystostomy?
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Make a nick incision in bladder (blade) and pass a hemostat through hole and have suture on distal end of ureter so not leaking urine into belly while operating, bring ureter into bladder and cut end that’s sutured, cut at angle and can spatulate trick is that ideally suture mucosa of ureter to mucosa of bladder with a simple interrupted pattern
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What is the drop in technique used during a ureteroneocystostomy?
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Hold bladder and just pull a segment of ureter into bladder so have a free tube in bladder and place one suture from bladder wall to ureter wall –not what they prefer or what most people do
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Compare the benefits of suture mucosa to mucosa VS the drop-in technique used during a ureteroneocystostomy?
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prefer mucosa to mucosa, drop in technique has more chance of stricture because of scar tissue; mucosa to mucosa= primary wound healing= minimal scar tissue; do not use simple continuous because form a purse string and shrinks stoma
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What causes ectopic ureters? Is it more common in dogs or cats?
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Congenital anomaly, more common in dogs (but rare)
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Are male or female dogs more commonly diagnosed with ectopic ureters? Why?
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Females, believe its because males have a longer ureter w/ a smaller diamer so clinical signs are not typically present so it goes undiagnosed, urethra in the male dog can be enough to maintain continence because longer and narrower
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What will be included in the history of a patient with an ectopic ureter?
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Urinary Incontinence that began early in life (<1 year)
-but can be older patient if went undiagnosed and incontinent whole life |
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What are the 4 types of ectopic ureters? What are each of them?
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1) Intramural ectopic ureter
2) Extramural ectopic ureter 3) Intramural ectopic ureter with double opening 4) Ureteral trough (not real ectopic ureter) |
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What is an intramural ectopic ureter?
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ureter appears to enter the bladder in correct spot at trigone, but doesn't open inside the bladder but instead keeps going into the urethra and opens there, with its course mostly intramural (in wall of bladder)
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What is an extramural ectopic ureter?
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Ureter never really goes into bladder where it should but instead bypasses whole bladder and enters urinary system after the sphincter of bladder
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What is an intramural ectopic ureter with a double opening?
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Ureter enters the bladder where it should and there's a stoma where it should be, but the oreter also continues intramurally and there's another opening in the urethra
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What is a ureteral trough?
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Ureter enters where it should and opens in the bladder where it should, but in the mucosa of the bladder there's a fold in the mucosa that creates a gutter that
goes beyond the urinary sphincter, so the sphincter is unable to close and squish it down; so when sphincter contracts the gutter allows a little urine to go beyond the sphincter and urine trickles down = urinary incontinence |
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What is the surgical correction for an extramural ectopic ureter?
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Ureteroneocystostomy -ligate ureter and sew ureter into the bladder
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What is most difficult about trying to correct an extramural ectopic ureter?
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Have to weigh splitting the pelvis VS infection because have to incise where the ureter connects to the urethra and have to split the pelvis to get to this, but if leave a piece of ureter it can get infected --> chronic UTI and have to come back in and finish the job
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How do you surgically correct an intramural ectopic ureter with no double opening?
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Usually can see the ureter in the wall of the bladder (lump) and trick is to making an opening in the bladder into the lumen of the ureter and then suture mucosa of ureter to mucosa of bladder so the ureter opens into the bladder
-if don't suture mucosa to mucosa= scarring= closes |
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What is the treatment for an intramural ectopic ureter with double openings?
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Just remove the part of the ureter that bypasses the urinary sphincter
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What animal are renal transplants most commonly done in? Why?
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Cats because the immunosuppression is still being figured out in dogs, in cats cyclosporin works very well
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True or false. When performing a nephrectomy in an intact dog you need to make sure to preserve the left testicular artery or left ovarian artery.
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False, need to preserve testicular or ovarian VEIN because they drain into the renal vein
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