SURGICAL AFFECTION OF

THE URINARY SYSTEM

Shaheer Ahmad
DVM 7th semester
(morning)
  THE URINARY SYSTEM
• Most important route of waste-product removal in the body.
• Removes nearly all the soluble waste products from blood and transports out of the body.
• Removes excess water from the body.

Parts of Urinary System

• Two kidneys
• Make urine and carry out other vital functions.
• Two ureters
• Carry urine to the urinary bladder. T.Adventia , T.muscularis , T.mucosa
• Urinary bladder
• Collects, stores and releases urine. T.Adventia , T.muscularis , T.mucosa
• Urethra
• Carries urine from the body to the external environment.
  URETHRA
•  The urethra is a tube that connects the urinary
bladder to the urinary meatus for the removal of fluids
from the body.
• Arteries
• Inferior Vesicle Artery
• Medial Rectal artery
• Internal pudendal Artery
• Veins
• Inferior Vesicle Vein
• Medial Rectal Vein
• Internal pudendal Vein
• Nerves
• Pudednal Nerve
• Pelvic splenchnic nerve
• Inferior hypogastric plexus

 
 EPITHELIUMS
• Kidney = Stratified Squamous Epithelium
• Bladder = Transitional Epithelium
• Ureter = Stratified Transitional Epithelium
• Urethra = Pseudo-columnar Stratified Columnar Epithelium Stratified Squamous
•
Male Urinary System
Female Urinary System
  BLOOD SUPPLY AND NERVE INNERVATIONS
• Blood flow to the two kidneys is normally about 22 percent of the cardiac output, or 1100 ml/min
• The renal veins are veins that drain the kidney. They connect the kidney to the inferior vena cava. Unlike the
right renal vein, the left renal vein often receives the left gonadal vein (left testicular vein in males, left ovarian
vein in females). It frequently receives the left suprarenal vein as well.
• Internal Pudic Artery
• Obturator Umbilical artery
• Internal Pudic Vein
• The renal arteries normally arise off the abdominal aorta and supply the kidneys with blood.
• Due to the position of the aorta, the inferior vena cava and the kidneys in the body, the right renal artery is
normally longer than the left renal artery. Up to a third of the total cardiac output can pass through the renal
arteries to be filtered by the kidneys
• Sympathetic nerves are the primary innervation of the kidneys branch of 3 rd & 4th Sacral Nerve
• These derive from the celiac mesenteric plexus and innervate blood vessels and renal tubules.
  TERMINOLOGY
• Nephrology- the study of the kidney.
• Diuresis- body has excess formation of urine
• Oliguria- Little urine is formed and passed
• Anuria- No urine is formed or passed
• Dysuria- Difficult urination
• Hematuria- Blood in urine
• Polyuria- Increased urine volume.
• Antidiuretic Hormone (ADH)- (may also be referred to as Vasopressin) promotes water
conservation by reabsorbing urine from collecting ducts.
• Aldosterone-mineral corticoid hormone secreted by cortex of adrenal gland. Stimulates kidney to
conserve sodium ions and water and eliminate potassium and hydrogen ions.
  ANESTHESIA AND ANTIBIOTICS
• Fluorinated gas anesthetics are nephrotoxic to some degree methoxyflurane >enflurane > isoflurane, > halothane.
Halothane is a widely used anesthetic agent for horses.
• Xylazine is a sedative hypnotic agent commonly administered to horses to facilitate examination or as a
preanesthetic medication.
• Gentamicin IV of 6.6 mg/kg of gentamicin IV every 24 hours is considered to be safe and efficacious in the
horse.
 SUTURE PATTERN USED :-

• In fact, non absorbable sutures should not be used for closure of any structure of the urinary tract.
• Non absorbable sutures serve as a nidus for formation of urinary concretions.
• As a technical point of urinary tract surgery, no suture material of any type should be placed in such
a fashion that it penetrates the urinary epithelium and is exposed to urine.
• When synthetic absorbable sutures are exposed to alkaline urine suture hydrolysis may be
accelerated.
• Simple continuous pattern in mucosa 
• Cushing pattern
• Lambert pattern
•  simple interrupted pattern
  COMMON SURGICAL PROCEDURES OF
URINARY TRACT

• Urinary Lithiasis;-
• Most stones that occur in the urinary tract are formed in the kidneys, but kidney stones can travel to other areas,
such as the ureters, and cause problems there.
• Various types of stones can develop in the kidneys from several different causes. A common cause is a metabolic
disorder involving calcium, proteins, or uric acid.
• Other causes are infections or obstructions of the urinary tract, the use of certain drugs, such as diuretics, or
vitamin deficiency.
• Symptoms
• Kidney liths seldom cause problems while they are forming, but movement of the stones irritates the urinary tract
and can cause severe pain; the irritation of the tissues may cause bleeding that will ultimately show up in the urine.
• Other symptoms may indicate obstruction of the flow of urine, and infection. In some cases obstruction of a ureter
can lead to failure of the kidney
• X-ray techniques can usually verify the cause of the patient's symptoms and locate the urinary stone. Most stones
cast a shadow on X-ray film, and the degree of obstruction by a stone can be determined.
 Most stones (75%) are composed mainly of
 calcium oxalate crystals;
 the rest are composed of
 calcium phosphate salts, uric acid
 (magnesium, ammonium, and phosphate
 URETEROLITHIASIS
• Most stones released by the kidney are small enough to pass through a ureter to the bladder and be excreted while
urinating.
• But if a stone is large enough it can become lodged in a ureter, causing excruciating pain that may be felt both in
the back and in the abdomen along the path of the ureter. Ureter stones often can be removed by manipulation,
using catheter tubes that are inserted through the bladder.
• If the stuck stone cannot be manipulated from the ureter, an operation in a hospital is required. However, the
surgical procedure is relatively simple and direct.
• An incision is made over the site of the stuck stone, and the ureter is exposed and opened just far enough to permit
removal of the stone. The operation is safe and requires perhaps a week in the hospital.
  RENAL LITHIASIS

• If the urinary stone is lodged in the kidney, the surgical procedure also is a relatively safe
• If one kidney is badly damaged it can be removed nephrectomy ,
• More modern techniques for removing kidney stones include the use of the lithotripter, a machine that shatters
the stones with an electrical shock wave. The wave is focused on the stones with the aid of a reflector and two
sophisticated X-ray machines that “aim” the target beam. No surgery is required, and the patient is usually back
at work within a week. A second means of attacking kidney stones is a drug, Potassium citrate , which keeps the
stones from forming. The drug actually corrects the metabolic disorders that cause the formation of kidney
stones.
 BLADDER TUMORS

• The first symptom of bladder tumor is blood in the urine. The tumor itself may cause no pain, but an early
complication could be an infection producing inflammation and discomfort in the region of the bladder.
• If the tumor blocks the normal flow of urine, the patient may feel pain or discomfort in the area of the kidneys;
this condition is most likely to happen if the tumor is located at the opening of a ureter leading from a kidney to
the bladder.
• An early examination of the bladder may fail to locate a small tumor, although X rays might show the growth as
a bit of shadow on the film, and obstruction of a ureter could be seen.
• Nonetheless, examination of the interior of the bladder by a cystoscopy is necessary to confirm the presence of
the tumor.
Treatment:-
• Most early and simple cases of bladder tumor can be corrected by a procedure called saucerization by an
instrument that removes the abnormal tissue, leaving a shallow wound that normally will grow over with healthy
tissue cells. But a tumor that invades deeply into the wall of the bladder requires more radical therapy, such as
surgery to cut away the part of the bladder that is affected by the growth.
• Radiation also may be employed to control the spread of tumor cells.
• Surgical Procedure
• If it is necessary to cut away a part of the bladder, the surgeon simply shapes a new but smaller organ from the
remaining tissues. If a total cystectomy is required to save the life of the patient, the entire bladder is removed,
along with the prostate. When the bladder is removed, a new path for the flow of urine is devised by the surgeons,
usually to divert the urine into the lower end of the intestinal tract.
Tumors of the Ureter or Urethra
• Tumors of the ureter, above the bladder, or of the urethra, below the bladder, may begin with symptoms
resembling those of a bladder tumor,
• X rays might show the growth as a bit of shadow on the normal flow of urine.
• Treatment also usually requires removal of the affected tissues with reconstructive surgery as needed to
provide for a normal flow of urine from the kidneys
 EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

• An extracorporeal noninvasive technique that uses shock waves to disintegrate urinary calculi.
• With this technique, calculi in the upper urinary tract are reduced to fragments, which pass spontaneously from the
collecting system and bladder in most patients.
• Size, location, and consistency of stone determine the number of shocks needed for fragmentation. In general,
between 500 and 2,000 shocks arc necessary to fragment and pulverize an intrarenal calculus sufficiently for
complete passage.
• Extracorporeal lithotripsy works best with stones between 4 mm and 20 mm in diameter that are still located in the
kidney
 PYELOLITHOTOMY:
• Simple pyelolithotomy is used for removal of calculi confined to the renal pelvis. Minimal dissection of the renal
sinus is usually needed, and exposure of the entire kidney is not re­quired.
  NEPHRECTOMY:-
• A nephrectomy is a surgical procedure for the removal of a kidney or section of a kidney
• Trans peritoneal Approach
• Nephrectomy, or kidney removal, is performed on patients with severe kidney damage from disease, injury, or
congenital conditions.
• These include cancer of the kidney (renal cell carcinoma); polycystic kidney disease (a disease in which cysts,
or sac-like structures, displace healthy kidney tissue); and serious kidney infections.
• It is also used to remove a healthy kidney from a donor for the purposes of kidney transplantation
• In the trans costal approach, the animal is anesthetized, placed in lateral recumbencey , clipped, and prepared
for aseptic abdominal surgery.
• A 30- to 40-cm skin incision is made over the 16th or 17th rib.
• The kidney is mobilized by digital circumferential dissection through perinephric fat to expose penetrating
capsular vessels
• Small capsular vessels and accessory renal arteries are electro-cauterized and ligated, respectively.
• The ureter o vascular pedicle is isolated, and the artery, vein, and ureter are individually double-ligated
 
• Unilateral right nephrectomy is performed through a
right 16th or 17th rib
• alternatively, at the 16th and 15th intercostal spaces
The ureter and blood vessels are disconnected, and the
kidney is then removed. The surgery can be done as open
surgery, with one incision, or as a laparoscopic procedure,
with three or four small cuts in the abdominal and flank
area.

• The periosteum of the rib and deep fascia are closed

with a synthetic absorbable suture material placed in
simple interrupted fashion.

• After removal of the affected kidney, the renal fossa is

lavage and again evaluated for evidence of
hemorrhage.
• The ureter is mobilized, ligated as far distally as
possible, and transected.
• Unilateral left nephrectomy of the horse is performed
in similar fashion using either a 17th or 18th rib
resection or a dorsal flank incision
 EVERSION OF URINARY
BLADDER
• Bladder eversion may occur in the female horse. It is associated with parturition and third-degree perineal
lacerations.
• Typically, the bladder is everted through the urethral sphincter, so that exposed mucosa extends beyond the ventral
commissure of the vulva
• Manual reduction followed by purse string suture placement around a Foley catheter is the treatment of choice.
• In chronic cases, however, the exposed bladder mucosa can become edematous and necrotic, requiring partial
cystectomy. Partial cystectomy can be accomplished in a standing patient with sedation, epidural anesthesia.
Eversion of BLadder
Foley Catheter
 UROPERITONEUM
• Uroperitoneum is defined as urine leakage into the peritoneal space results in the development of uremia
and severe electrolyte and acid–base imbalances.
• Rupture of the foal’s bladder occurs because of congenital defects or compressive forces associated with
parturition.
• The rupture occurs along the dorsal or dorso cranial margin of the foal’s bladder
because of the inherently thin wall in that area. Foals 1 to 5 days old are affected
• Clinical signs include depression, progressive anorexia, and abdominal distention with mild to moderate
colic. Some foals that experience severe abdominal distention become dyspnea.
• Affected foals are capable of voiding a stream of urine, although increased frequency and reduced volume
of urine flow can be expected.
Rupture of the pediatric equine bladder usually occurs
longitudinally along the dorsal or dorsocranial aspect.
 PERSISTENT OR PATENT URACHUS
• The urachus is a fibrous remnant of the allantois, a canal that drains the urinary bladder of the fetus that joins
and runs within the umbilical cord
• Persistent or patent urachus is a condition of young foals in which the urachus fails to close spontaneously at or
shortly after parturition.
• Patent urachus has been associated with development of septic arthritis, septicemia due to Streptococcus
species, Actinobacillus species, and Escherichia coli.
• Affected foals show moisture around the navel region.
• Some foals drip or stream urine from the umbilicus when posturing to urinate
• Foals with septic omphalophlebitis may have grossly enlarged navels and purulent drainage
• Most uncomplicated cases of congenital patent urachus are treated medically by systemic antimicrobial therapy
and topical application of cauterizing or astringent compounds such as phenol, Lugol’s iodine, or silver nitrate.
• surgical management are operated on through a modified midline celiotomy for exploration,
evaluation, and resection of the urachus with its associated umbilical vascular elements.

Urine is coming both out of penis and naval

A patent or persistent urachus is usually recognized by Marked enlargement of the umbilicus is evident in this
its male foal with septic omphalophlebitis and patent urachus.
moist and fistulous appearance
 CYSTORRHAPHY
• Cystorrhaphy is indicated for disruption of the bladder
• The anesthetized patient is positioned in dorsal recumbency.
• An appropriate-size rubber catheter is passed through the urethra and secured in the bladder to ensure outflow of
urine and to permit intraoperative lavage of the base of the bladder.
• In the adult female patient, the surgeon should make a 15- to 18-cm caudal midline incision that extends caudally
from a point 2 to 5 cm cranial to the umbilicus.
• In the male patient, the cranial aspect of the incision is identical however, the skin and subcutaneous layers of the
caudal incision should be directed 2 to 4 cm para median to the prepuce .
• After the peritoneal cavity has been opened and the bladder is exposed
• Site of rupture is located, in the foal may be the urachus as well as the dorsal or ventral bladder.
Once the tear is identified, the wound margins are
debrided.

The use of monofilament stay sutures to support the bladder

during primary repair is recommended.

Surgical closure of the tear should be accomplished

in two layers: an interrupted pattern in the first layer, A rupture of the urachus
followed by a continuous inverting pattern (located at the tip of the
hemostatic forceps) is
readily apparent on
inspection of the cranial
bladder.