Do's and Don'ts in Urologic Surgery

Do’s and don’ts in urologic surgery

Surgery of the urinary tract can be divided in surgery of the kidney and ureter (the upper urinary tract, UUT) and surgery of the bladder and urethra (the lower urinary tract, LUT). Animals with disease of the UUT may show symptoms of acute or chronic renal failure when both kidneys are affected. Animals with sufficient renal function may show signs that indicate a problem of the urinary tract like hematuria but can also show indistinct symptoms like abdominal pain, fever, loss of appetite and weight loss. In case of disease of the LUT the animal will show mild to severe symptoms of dysuria, hematuria, pollakisuria and/or active or passive urinary incontinence. Urethral disease may cause signs of acute or chronic renal failure in case of urethral obstruction, which should be considered as a medical emergency rather than a surgical emergency. In all cases the patient has to be stabilized for anesthesia. In this lecture surgical techniques for the UUT and LUT will be discussed.

Surgery of the kidney and ureter
Ureteronephrectomy (excision of the kidney and ureter) is indicated for renal neoplasia, uncontrollable haemorrhage, pyelonephritis resistant to medical treatment, severe hydronephrosis or ureteral abnormalities that cannot be solved otherwise. Renal function in the opposite kidney is essential. The kidneys lie in the retroperitoneal space lateral to the aorta and the caudal vena cava. To expose the kidney a ventral midline abdominal incision is performed from the xiphoid to caudal to the umbilicus. For an optimal sight the falciform ligament is resected. The peritoneum over the kidney is incised. Next the kidney can be freed from its attachments mostly by blunt dissection. By elevating the kidney the renal artery and vein can be located. The renal artery often bifurcates in dorsal and ventral branches. The artery is double ligated with absorbable suture, and then the renal vein is ligated similarly. The left ovarian and testicular veins drain into the renal vein and should not be ligated in intact dogs. The ureter is ligated as close as possible to the bladder and transected.