17 18 Surgery of the Bladder and Urethra

Cystotomy

This is the surgical incision into the urinary bladder

Cystostomy

This is the creation of an opening into the bladder

Cystectomy

This is the removal of a portion of the urinary bladder

Urethrotomy

This is an incision into the urethra

Cystolithiasis

This is urinary bladder calculi

Cystolithectomy

This is the removal of urinary bladder calculi

Trigone

This is the area of the bladder that is a smooth triangular portion of the mucous membrane at the base of the bladder

Prepubic catheterization

This is performed to provide cutaneous urinary diversion in animals with urethral obstruction or trauma

Uroabdomen

This is the presence of urine in the abdominal cavity

Urethrostomy

This is the creation of a permanent fistula into the urethra, generally performed for irreparable or recurrent urethral stricture, or to prevent repeated obstruction

trigone

What is this?

Removal of calculi

What is the most common indication for a cystotomy?

Ease of access and identification of urethral openings if necessary

Why is ventral exposure often preferred for a cystotomy, away from the urethra?

Cystotomy

What is this?

Goal of closure is to obtain a watertight seal that will not promote formation of calculi

What is the goal when closing cystotomies?

In normal bladders: single layer appositional suture pattern is typically adequate (a single layer appositional closure is sufficient if the bladder wall is thick)

What closure do you do for closure of cystotomy?

Absorbable monofilament

What is not believed to be associated with formation of calculus with cystotomies? (suture type)

Penile, membranous, and prostatic urethra

What is the urethra of male dogs composed of?

FALSE: CANNOT diagnose the type of stone on the basis of crystals found in the urine

TRUE OR FALSE: You can diagnose stones or calculi based on the crystals found in the urine.

Cystotomy, retrohydropropulsion, urethrotomy, laparoscopic assisted cystoscopy

What surgical techniques can you use for removal of urinary calculi

retrohydropropulsion (to propel urethral stones back into bladder)

What is this, where the goal is to propel urethral stones back into the bladder by dilating the urethra?

cystotomy

If stones can be flushed into the bladder, you should preferentially perform cystotomy/urethrotomy

MALE

You can only use retrohydropropulsion in male/female dogs.

Uncommon

Complications with cystotomy are common/uncommon

Failure to remove all stones

Failure with cystotomy is overall uncommon. What is the most common complication?

HEMORRHAGE

What is the MAIN COMPLICATION with urethrotomy?

uncommon

Urethral stricture is common/uncommon with urethrotomy.

Traditional lithotripsy (shockwaves break up stones), laser lithotripsy

Name the nonsurgical techniques for removal of urinary calculi

Cystostomy (prepubic catheterization)

Name something you can do to maybe help prevent overdistention of the bladder after surgery or for animals with bladder atony?

Cystostomy or prepubic catheterization

What is this?

Catheters for cystostomy (prepubic catheterization)

What are these?

Foley catheter

What is this for prepubic catheterization for 5-7 days?

Mushroom tip catheter

What is this for prepubic catheterization for 3-4 days?

Low profile gastrostomy tube

What is this for prepubic catheterization which is more permanent?

CYSTOTOMY

To prevent possible postoperative urethral stricture, cystotomy/urethrotomy is preferred over the other if calculi can be advanced back into the bladder by retrohydropropulsion.

Urethrotomy

You would perform this procedure in male dogs to remove urethral calculi that CANNOT be retrohydropropulsed, to facilitate placement of catheter into the bladder, and to biopsy obstructive lesion.

Prescrotal urethrotomy

You would perform this procedure in male dogs to remove calculi from the distal penile urethra, and to place Foley catheters into the urinary bladder if the catheter is sufficient length or obstruction is distal to proposed incision site

Prescrotal urethrotomy

What is this the site for?

Perineal urethrotomy

You would perform this procedure occasionally to remove calculi lodged at the ischial arch or to place catheters into the bladder of large male dogs.

Perineal urethrotomy

Which urethrotomy site do you close after the procedure to prevent subcutaneous urine leakage?

Perineal urethrotomy

What is this?

Perineal urethrotomy

What is the bottom image the site for?

1. recurrent obstructive calculi which cannot be managed medically

2. calculi that cannot be removed via retrohydropropulsion or urethrotomy

3. urethral stricture

4. urethral/penile neoplasia

5. preputial neoplasia requiring penile amputation

Name the indications for urethrostomy

a. recurrent obstructive calculi which cannot be managed medically

c. urethral stricture

e. calculi which cannot be removed via retrohydropropulsion

f. urethral/penile neoplasia

g. preputial neoplasia requiring penile amputation

Select the indications for urethrostomy:

a. recurrent obstructive calculi which cannot be managed medically

b. calculi after it has been retrohydropropulsed

c. urethral stricture

d. urethral dilation

e. calculi which cannot be removed via retrohydropropulsion

f. urethral/penile neoplasia

g. preputial neoplasia requiring penile amputation

urethrostomy

What is this the closure for?

1. prescrotal

2. scrotal

3. perineal

4. prepubic

Name the TYPES of urethrostomies for dogs

Perineal urethrostomy

This procedure often causes unacceptable urine scalding so must be closed and is only used in dogs that have urinary problems that cannot be solved via scrotal/prescrotal urethrostomy

Canine perineal urethrostomy AND canine prescrotal urethrostomy

What is this the site for?

In URETHROSTOMY, urethral mucosa is sutured to the skin. In urethrotomy you leave to heal by second intention or just close with normal apposition of tissue layers

What is the difference between canine prescrotal urethrotomy and urethrostomy?

The green portion, the urethral mucosa, would be sutured to the skin

This is illustrating a urethrotomy closure. How would urethrostomy closure be different?

Canine scrotal urethrostomy. Perform a scrotal ablation

What is this? What do you perform with it?

Canine scrotal urethrostomy

What is the preferred site for urethrostomy because the urethra is wider and more superficial and surrounded by less cavernous tissue?

Feline perineal urethrostomy

You would perform this surgery to prevent recurrence of obstruction in male cats with feline idiopathic cystitis, to treat obstruction that cannot be eliminated by catheterization, and to treat strictures secondary to urethral obstruction/catheterization

CANINE

Which often has a urine scalding problem: canine/feline perineal urethrostomy?

Feline perineal urethrostomy

What is this, where you free the penis and distal urethra, elevate the penis dorsally, and transect muscles at insertion on ischium?

Pass a closed halstead mosquito hemostat up the urethra. If hemostat can pass to level of boxlock without resistance, there is about 5 mm in diameter so urinary blockage doesn't occur

What should you pass up the urethra in a feline perineal urethrostomy to ensure that urethra has an adequate width? Why does this work?

You need to make sure the urethral opening is sufficient in diameter. If it is not, the patient is predisposed to urinary tract blockage which defeats the purpose of performing the surgery

What is the point of passing a Halstead mosquito hemostat up the urethra after a feline perineal urethrostomy?