Surgery of the Urethra Quiz

1. Surgery of the Urethra Quiz Elaina Turner

2. What are the consequences to a dog or cat of acute complete urethral obstruction? • Acute renal failure followed by death in a few days if untreated.

3. What are the consequences of chronic partial urethral obstruction? • Progressive atrophy and destruction of nephrons and chronic renal failure.

4. What is the most common cause of urethral obstruction in a male dog? • Urethroliths

5. Explain why urethroliths do not cause obstruction in female dogs. • The female dog has a wider and shorter urethra.

6. What is the most common cause of urethral obstruction in male cats? • FLUTD

7. What is the clinical picture of a female cat with this condition? • Look in sam notes

8. What are the expected acid-base and electrolyte abnormalities in the patient with complete urethral obstruction? • Increased K, Cl • Decreased Na+ • Elevated creatnine and urea

9. What 2 steps, generally, must be taken to relieve electrolyte and acid-base abnormalities in these patients? • Fluids • Un-obstruct

10. List the common sites of obstruction in the dog’s urethra.

11. What are the 4 goals of treatment in the dog with urethral obstruction? • Preserve renal function • Correct uremia and electrolyte and acid-base abnormalities • Prevent/eliminate urinary tract infection • Eliminate cause of obstruction

12. What is the 1st procedure that should be tried before urethrotomy? Why? • Retrograde hydropulsion • This is done to flush the calculi into the bladder so that a cystotomy may be done. This procedure is technically easy to do.

13. Why does medical treatment of urethral calculi not work well, even for calculi that are dissolvable? • Urethroliths cannot usually be dissolved medically because they are not continuously exposed to urine.

14. Why would medical treatment not be recommended even if it worked well? • They would just lodge further down in the urethra on their way out.

15. What are the indications for urethrotomy in the dog? • Outflow obstruction • Retrograde hydropulsion is unsuccessful (if calculi can be flushed into bladder, cystotomy is done) • Combination of urethrotomy and cystotomy may be required.

16. What are the 2 sites where a urethrotomy may be done? • Prescrotal • Urethroliths lodged at caudal end of penis • Perineal • Urethroliths lodged at brim of pelvis

17. Which of the previous sites has more associated complications? • Perineal

18. What are the indications for urethrostomy in the dog? • Recurrent urethral obstruction that cannot be managed medically • Obstruction that cannot be removed by retropulsion or urethrotomy • Urethral, penile or perputial neoplasia or severe trauma

19. Name the 4 sites where a urethrostomy may be done? • Scrotal (location of choice) – dog • Prescrotal – dog • Antepubic (prepubic) – dog and cat • Perineal – dog and location of choice in the cat

20. What are the advantages of doing a scrotal urethrostomy in the dog? • Urethral diameter is larger than in more distal (prescrotal) urethra • Less erectile tissue is present than at prescrotal site • Urethra is more superficial than in perineal location

21. Which urethrostomy site is avoided b/c of difficulty of sx and high incidence of post-op complications? • Perineal urethrostomy in the dog • Urine scald • Ascending UTI

22. Which urethrostomy site may be used as a salvage procedure if the pelvic urethra has been destroyed by trauma? • Antepubic urethrostomy

23. Why is urethrotomy not done in the male cat? • How are you going to do a urethrotomy when they have no prepuce • Take a look at caleb and try to imagine doing the procedure • What is the procedure? • Cut a hole through the penis along the part in the prepuce so that urine comes out there instead

24. What are the indications for urethrostomy in the cat? • Irreversible mural or extramural lesions causing recurrent or persistent obstruction • Frequent recurrence of urethral obstruction despite appropriate medical therapy. • Do not do this procedure the 1st time the cat obstructs.

25. What is a urethrostomy? • Surgicalformation of a permanentopening between the urethra and the skin.

26. What is a urethrotomy? • An incision of the urethra, esp. incision for relief of urethral stricture

27. What are the 2 sites for urethrostomy in male cats? • Perineal • Antepubic

28. What is the preferred site for urethrostomy in the cat? • Perineal

29. What are the complications of perineal urethrostomy in the cat? • Recurrent FLUTD and bacterial cystitis • Urethral stricture – may require 2nd urethrostomy • Urolithiasis

30. Which of the previous complications are caused by poor surgical technique, and which are secondary to creating a wider urethral orifice? • Urethral stricture is due to poor surgical technique (muscles not cut on each side or overcauterized) • Wider urethral orifice -

31. List 3 indications and complications of antepubic urethrostomy. • Indications • Salvage procedure for stricture, neoplasia, or trauma of perineal, pelvic or abdominal urethra • Recurrent stricture of perineal urethrostomy • Complications • Urine scalding • Ascending urinary tract infection • Potential for urinary incontinence

32. Compare intrapelvic and extrapelvic urethral lacerations with respect to clinical signs, clinical pathological abnormalities, diagnostic techniques and treatment?

33. How does treatment of complete transection of the urethra differ from treatment of urethral laceration? • Laceration – rarely needs to be sutured, can put in a urinary catheter (closed system) and will heal to the diameter of the catheter (use the largest possible) • Transection – possible resection and anastomosis or salvage procedure.