Surgery of the urinary tract

• Indications for renal surgery - over view

  Nephrectomy

  Renal biopsy

  Nephrotomy

  Normal function of the contralateral kidney is a prerequisite for performing nephrectomy.

  The presence of azotaemia or persistent isosthenuria is a contraindication for nephrectomy.
• Indications for renal surgery - Nephrectomy

  Renal and ureteral neoplasia

  Trauma

  Persistent renal haematuria

  Polynephritis associated with polycystic disease

  End-stage hydronephrosis

  Single renal cysts associated with renal disease

  Renal or perirenal abscessation

  Chronic end-stage pyelonephritis

  Renal disease associated with ectopic ureter.
• Indications for renal surgery - renal biopsy

  Investigation of proteinuric renal disease

  Renomegaly (or renal mass)

  Familial renal disease

  • Renal amyloidosis
  • Renal dysplasia
  • Polycystic kidneys
  • Basement membrane disorder
• Indications for renal surgery - nephrotomy

  Removal of renal calculi
• Complications of renal surgery

  Renal pain

  Haemorrhage

  • Haemoabdomen
  • Haematuria

  retroperitoneal and peritoneal urine leakage (uroabdomen)

  Urinary tract infection

  Compromise of renal function (renal failure)
• Urinary bladder - cystotomy

  Calculi (urolithiasis)

  Biopsy

  Tumour

  Ureteral ectopia
• Cystotomy closure

  Absorbable monofilament (e.g. polydioxanone, polyglyconate, poliglecaprone, glycomer 631)

  Size:

  • 4/0 or 3/0 cats
  • 4/0, 3/0 or 2/0 dogs

  Pattern:

  • One-layer - full thickness (simple interrupted, simple continuos, continuous inverting (e.g. Connel, Cushing, Lembert)
  • Two-layer
  • Submucosal/mucosa
  • Seromuscular
• Cystotomy closure

  No consistent agreement on best suture pattern - classically, the bladder was closed in two layers.

  SiNile layer continuous appositional closure +/- second layer of inverting suture if concerned about leakage in thin walled bladder.

  Use an atraumatic needle

  Drape omentalisation of the sire of repair.
• Urinary bladder - partial cystectomy

  Discrete, operable neoplasia

  Discrete, localised nidus of infection

  • Persistent urachal remnant with infection.
• Tube cystostomy - indications

  Urinary diversion in animals with either:

  • Functional or mechanical obstruction of the bladder or urethra.
  • Excessive urine retention (atonic bladder)
  • Post bladder/ urethral surgery (urinary bypass)