Surgical interventions of the horses urinary system

1. SURGICAL AFFECTION OF
THE URINARY SYSTEM
Shaheer Ahmad
DVM 7th semester
(morning)

2.  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.

3.  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

4.  EPITHELIUMS
• Kidney = Stratified Squamous Epithelium
• Bladder = Transitional Epithelium
• Ureter = Stratified Transitional Epithelium
• Urethra = Pseudo-columnar Stratified Columnar Epithelium Stratified Squamous
•

5. Male Urinary System

6. Female Urinary System

7.  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 3rd & 4th Sacral Nerve
• These derive from the celiac mesenteric plexus and innervate blood vessels and renal tubules.

8.  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.

9.  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.

10.  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

11.  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.

12. •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

14. 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.

15. 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.

17. 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.

19. 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.

20. 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

21.  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

23.  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.

24.  NEPHRECTOMY:-
• A nephrectomy is a surgical procedure for the removal of a kidney or section of a kidney
• Trans peritoneal Approach

25. • 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

26. • Unilateral right nephrectomy is performed
through a right 16th or 17th rib
• alternatively, at the 16th and 15th intercostal
spaces
• The periosteum of the rib and deep fascia are
closed with a synthetic absorbable suture
material placed in simple interrupted fashion.
 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.
• 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

27. 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.

28. Eversion of BLadder

29. Foley Catheter

30. 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.

31. Rupture of the pediatric equine bladder usually occurs
longitudinally along the dorsal or dorsocranial aspect.

32. 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.

33. • 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

34. A patent or persistent urachus is usually
recognized by its
moist and fistulous appearance
Marked enlargement of the umbilicus is evident in this
male foal with septic omphalophlebitis and patent
urachus.

35. 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.

36. A rupture of the
urachus (located at
the tip of the
hemostatic forceps) is
readily apparent on
inspection of the
cranial
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,
followed by a continuous inverting pattern