surgical anatomy surgery of the kidney - kisallatsebeszet.hu · surgery of the kidney dr. t....
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Surgery of the KidneySurgery of the KidneySurgery of the KidneySurgery of the Kidney
Dr. T. Németh, DVM, Ph.DDr. T. Németh, DVM, Ph.DDr. T. Németh, DVM, Ph.DDr. T. Németh, DVM, Ph.D
Surgical anatomySurgical anatomySurgical anatomySurgical anatomy
Surgical Diseases of the Surgical Diseases of the KidneyKidney
Surgical Diseases of the Surgical Diseases of the KidneyKidney
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
Surgical Diseases of the Surgical Diseases of the KidneyKidney
Surgical Diseases of the Surgical Diseases of the KidneyKidney
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
HydronephrosisHydronephrosisHydronephrosisHydronephrosis
Forms:– congenital (unilateral - bilateral)– acquired (unilateral - bilateral)
Etiology ureter-occlusion ! (ureter-stricture, -compression, - calculus, -neoplasia, -stenosis)
Forms:– congenital (unilateral - bilateral)– acquired (unilateral - bilateral)
Etiology ureter-occlusion ! (ureter-stricture, -compression, - calculus, -neoplasia, -stenosis)
UreterUreter--occlusionocclusion(experimental)(experimental)
UreterUreter--occlusionocclusion(experimental)(experimental)
Total obstruction– Intra-ureteral pressure increases within the first 5 hours
then decreases until12 to 24 hours– Blood perfusion of the kidney drops to 40% for the first
24 hours then to 20% until the end of 2nd week– GFR falls too
Post-obstruction regeneration– After 1-week ureter obstruction GFR returns to 65% then
to 100% within 5 weeks– After 2-week ureter occlusion GFR returns to 46% within
4 months
Total obstruction– Intra-ureteral pressure increases within the first 5 hours
then decreases until12 to 24 hours– Blood perfusion of the kidney drops to 40% for the first
24 hours then to 20% until the end of 2nd week– GFR falls too
Post-obstruction regeneration– After 1-week ureter obstruction GFR returns to 65% then
to 100% within 5 weeks– After 2-week ureter occlusion GFR returns to 46% within
4 months
HydronephrosisHydronephrosisHydronephrosisHydronephrosis
Diagnosis:– generally asymptomatic (unilateral)– physical findings: abdominal palpation (rare)– laboratory: uraemia (bilateral)– US (!)– X-ray: plain, excretory urography
Therapy: nephrectomy
Diagnosis:– generally asymptomatic (unilateral)– physical findings: abdominal palpation (rare)– laboratory: uraemia (bilateral)– US (!)– X-ray: plain, excretory urography
Therapy: nephrectomy
HydronephrosisHydronephrosisUltrasonographyUltrasonography
HydronephrosisHydronephrosisUltrasonographyUltrasonography
HydronephrosisHydronephrosisHydronephrosisHydronephrosis
Diagnostics:– generally asymptomatic (unilateral)– physical findings: abdominal palpation (rare)– laboratory: uremia (bilateral)– US (!)– X-ray: plain (excretory urography)
Therapy: nephrectomy
Diagnostics:– generally asymptomatic (unilateral)– physical findings: abdominal palpation (rare)– laboratory: uremia (bilateral)– US (!)– X-ray: plain (excretory urography)
Therapy: nephrectomy
HydronephrosisHydronephrosisExcretory urographyExcretory urographyHydronephrosisHydronephrosisExcretory urographyExcretory urography
HydronephrosisHydronephrosisHydronephrosisHydronephrosis
Diagnostics:– generally asymptomatic (unilateral)– physical findings: abdominal palpation (rare)– laboratory: uremia (bilateral)– US (!)– X-ray: plain (excretory urography)
Therapy: nephrectomy
Diagnostics:– generally asymptomatic (unilateral)– physical findings: abdominal palpation (rare)– laboratory: uremia (bilateral)– US (!)– X-ray: plain (excretory urography)
Therapy: nephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
NephrectomyNephrectomyNephrectomyNephrectomy HydronephrosisHydronephrosisNephrectomyNephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
HydronephrosisHydronephrosisNephrectomyNephrectomy
Surgical Diseases of the Surgical Diseases of the KidneyKidney
Surgical Diseases of the Surgical Diseases of the KidneyKidney
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
NephrolithiasisNephrolithiasisNephrolithiasisNephrolithiasis IncidenceIncidence, Aetiology, Aetiology
–– uncommonuncommon–– breedbreed--predispositionpredisposition ((e.ge.g. dalmatian, bishon). dalmatian, bishon)
–– alimentaryalimentary backgroundbackground ((e.ge.g. protein . protein overfeedingoverfeeding))
–– pyelonephritispyelonephritis–– portovascularportovascular anomalyanomaly ((ammoniumammonium urateurate !)!)
–– hypercalcemia hypercalcemia (malignancies)(malignancies)
–– struvitestruvite (Mg(NH(Mg(NH44)PO)PO44), urate (Dalmatian) ), urate (Dalmatian) CaCa--phosphate, Caphosphate, Ca--oxalate (bishon), oxalate (bishon), silicatesilicate
IncidenceIncidence, Aetiology, Aetiology–– uncommonuncommon–– breedbreed--predispositionpredisposition ((e.ge.g. dalmatian, bishon). dalmatian, bishon)
–– alimentaryalimentary backgroundbackground ((e.ge.g. protein . protein overfeedingoverfeeding))
–– pyelonephritispyelonephritis–– portovascularportovascular anomalyanomaly ((ammoniumammonium urateurate !)!)
–– hypercalcemia hypercalcemia (malignancies)(malignancies)
–– struvitestruvite (Mg(NH(Mg(NH44)PO)PO44), urate (Dalmatian) ), urate (Dalmatian) CaCa--phosphate, Caphosphate, Ca--oxalate (bishon), oxalate (bishon), silicatesilicate
NephrolithiasisNephrolithiasisNephrolithiasisNephrolithiasis
DiagnosticsDiagnostics–– unilaterallyunilaterally asymptomaticasymptomatic–– anorexia, lethargyanorexia, lethargy–– „irresponsive„irresponsive” ” hematuriahematuria, , proteinuriaproteinuria–– crystalscrystals inin thethe sedimentsediment–– bilaterallybilaterally: : uremiauremia–– XX--rayray ((plainplain, , contrastcontrast))–– USUS
DiagnosticsDiagnostics–– unilaterallyunilaterally asymptomaticasymptomatic–– anorexia, lethargyanorexia, lethargy–– „irresponsive„irresponsive” ” hematuriahematuria, , proteinuriaproteinuria–– crystalscrystals inin thethe sedimentsediment–– bilaterallybilaterally: : uremiauremia–– XX--rayray ((plainplain, , contrastcontrast))–– USUS
NephrolithiasisNephrolithiasisPlain radiographyPlain radiography
NephrolithiasisNephrolithiasisPlain radiographyPlain radiography
NephrolithiasisNephrolithiasisExcretory urographyExcretory urographyNephrolithiasisNephrolithiasisExcretory urographyExcretory urography
NephrolithiasisNephrolithiasisNephrolithiasisNephrolithiasis
DiagnosticsDiagnostics–– unilaterallyunilaterally asymptomaticasymptomatic–– „„irresponsiveirresponsive” ” hematuriahematuria, , proteinuriaproteinuria–– crystalscrystals inin thethe sedimentsediment–– bilaterallybilaterally: : uremiauremia–– XX--rayray ((plainplain, , contrastcontrast))–– USUS
DiagnosticsDiagnostics–– unilaterallyunilaterally asymptomaticasymptomatic–– „„irresponsiveirresponsive” ” hematuriahematuria, , proteinuriaproteinuria–– crystalscrystals inin thethe sedimentsediment–– bilaterallybilaterally: : uremiauremia–– XX--rayray ((plainplain, , contrastcontrast))–– USUS
NephrolithiasisNephrolithiasisUltrasonographyUltrasonography
NephrolithiasisNephrolithiasisUltrasonographyUltrasonography
NephrolithiasisNephrolithiasisNephrolithiasisNephrolithiasisTherapyTherapy
MedicalMedical–– dissolutiondissolution dietdiet++drugdrug ((struvitstruvit, , urateurate, , cystinecystine))–– lithotripsylithotripsy (extra(extra-- oror intracorporealintracorporeal))
SurgicalSurgical–– pyelotomypyelotomy–– nephrotomynephrotomy–– nephrectomynephrectomy
TherapyTherapyMedicalMedical
–– dissolutiondissolution dietdiet++drugdrug ((struvitstruvit, , urateurate, , cystinecystine))–– lithotripsylithotripsy (extra(extra-- oror intracorporealintracorporeal))
SurgicalSurgical–– pyelotomypyelotomy–– nephrotomynephrotomy–– nephrectomynephrectomy
NephrolithiasisNephrolithiasisPyelotomyPyelotomy
NephrolithiasisNephrolithiasisPyelotomyPyelotomy
NephrolithiasisNephrolithiasisNephrolithiasisNephrolithiasisTherapyTherapy
MedicalMedical–– dissolutiondissolution dietdiet++drugdrug ((struvitstruvit, , urateurate, , cystinecystine))–– lithotripsylithotripsy (extra(extra-- oror intracorporealintracorporeal))
SurgicalSurgical–– pyelotomypyelotomy–– nephrotomynephrotomy–– nephrectomynephrectomy
TherapyTherapyMedicalMedical
–– dissolutiondissolution dietdiet++drugdrug ((struvitstruvit, , urateurate, , cystinecystine))–– lithotripsylithotripsy (extra(extra-- oror intracorporealintracorporeal))
SurgicalSurgical–– pyelotomypyelotomy–– nephrotomynephrotomy–– nephrectomynephrectomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrotomyNephrotomy
NephrolithiasisNephrolithiasisNephrolithiasisNephrolithiasisTherapyTherapy
MedicalMedical–– dissolutiondissolution dietdiet++drugdrug ((struvitstruvit, , urateurate, , cystinecystine))–– lithotripsylithotripsy (extra(extra-- oror intracorporealintracorporeal))
SurgicalSurgical–– pyelotomypyelotomy–– nephrotomynephrotomy–– nephrectomynephrectomy
TherapyTherapyMedicalMedical
–– dissolutiondissolution dietdiet++drugdrug ((struvitstruvit, , urateurate, , cystinecystine))–– lithotripsylithotripsy (extra(extra-- oror intracorporealintracorporeal))
SurgicalSurgical–– pyelotomypyelotomy–– nephrotomynephrotomy–– nephrectomynephrectomy
NephrectomyNephrectomyNephrectomyNephrectomy NephrolithiasisNephrolithiasisNephrectomyNephrectomy
NephrolithiasisNephrolithiasisNephrectomyNephrectomy
NephrolithiasisNephrolithiasisNephrectomyNephrectomy
NephrolithiasisNephrolithiasisNephrectomyNephrectomy
Surgical Diseases of the Surgical Diseases of the KidneyKidney
Surgical Diseases of the Surgical Diseases of the KidneyKidney
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
Renal neoplasiaRenal neoplasiaRenal neoplasiaRenal neoplasia
Incidence:– in dogs: 1,7-2% of tumours
– in cats: 2,5% of tumours
– benign (adenoma, interstitial tumor)
– malignant (tubular cell carcinoma; cystadenocarcinoma, TCC, SCC, HSA, LSA/cat, FSA, congenital nephroblastoma)
– metastasis (LSA/cat!, liver, biliary tract)
Incidence:– in dogs: 1,7-2% of tumours
– in cats: 2,5% of tumours
– benign (adenoma, interstitial tumor)
– malignant (tubular cell carcinoma; cystadenocarcinoma, TCC, SCC, HSA, LSA/cat, FSA, congenital nephroblastoma)
– metastasis (LSA/cat!, liver, biliary tract)
Renal neoplasiaRenal neoplasiaRenal neoplasiaRenal neoplasiaDiagnosis: non specific signs
– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial;total)– Chemotherapy + Local radiotherapy
Diagnosis: non specific signs– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial;total)– Chemotherapy + Local radiotherapy
Renal neoplasiaRenal neoplasiaUS guided kidney biopsyUS guided kidney biopsy
Renal neoplasiaRenal neoplasiaUS guided kidney biopsyUS guided kidney biopsy
Renal neoplasiaRenal neoplasiaRenal neoplasiaRenal neoplasiaDiagnosis: non specific signs
– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial;total)– Chemotherapy + Local radiotherapy
Diagnosis: non specific signs– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial;total)– Chemotherapy + Local radiotherapy
Renal neoplasiaRenal neoplasiaRenal carcinoma Renal carcinoma -- Plain radiographyPlain radiography
Renal neoplasiaRenal neoplasiaRenal carcinoma Renal carcinoma -- Plain radiographyPlain radiography
Renal neoplasiaRenal neoplasiaRenal neoplasiaRenal neoplasiaDiagnosis: non specific signs
– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial; total)– Chemotherapy + Local radiotherapy
Diagnosis: non specific signs– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial; total)– Chemotherapy + Local radiotherapy
Renal neoplasiaRenal neoplasiaPartial nephrectomyPartial nephrectomyRenal neoplasiaRenal neoplasiaPartial nephrectomyPartial nephrectomy Renal neoplasiaRenal neoplasiaRenal neoplasiaRenal neoplasia
Diagnosis: non specific signs– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial; total)– Chemotherapy + Local radiotherapy
Diagnosis: non specific signs– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial; total)– Chemotherapy + Local radiotherapy
Renal neoplasiaRenal neoplasiaRenal carcinoma Renal carcinoma -- Plain radiographyPlain radiography
Renal neoplasiaRenal neoplasiaRenal carcinoma Renal carcinoma -- Plain radiographyPlain radiography
Renal neoplasiaRenal neoplasiaRenal carcinoma Renal carcinoma -- Plain radiographyPlain radiography
Renal neoplasiaRenal neoplasiaRenal carcinoma Renal carcinoma -- Plain radiographyPlain radiography
Renal neoplasia Renal neoplasia Metastatic renal tumour Metastatic renal tumour
(from liver biliary carcinoma(from liver biliary carcinoma))
Renal neoplasia Renal neoplasia Metastatic renal tumour Metastatic renal tumour
(from liver biliary carcinoma(from liver biliary carcinoma))
Renal neoplasiaRenal neoplasiaRenal neoplasiaRenal neoplasiaDiagnosis: non specific signs
– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial; total)– Chemotherapy + Local radiotherapy???
Diagnosis: non specific signs– anorexia, weight loss– polycytemia (in cat)– polyuria, polydypsia, haematuria, tumour cells in
urine sediment , uremia– US (FNA, biopsy) – X-ray (excretory urography)
Therapy:– Surgical:nephrectomy (partial; total)– Chemotherapy + Local radiotherapy???
Surgical Diseases of the Surgical Diseases of the KidneyKidney
Surgical Diseases of the Surgical Diseases of the KidneyKidney
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
HydronephrosisHydronephrosis
NephrolithiasisNephrolithiasis
Renal neoplasiaRenal neoplasia
Renal injuriesRenal injuries
Renal injuriesRenal injuriesRenal injuriesRenal injuries
Incidence:–blunt trauma (contusion; hematoma,
rupture, laceration, avulsion)
– sharp trauma (stab, shot injury)
Incidence:–blunt trauma (contusion; hematoma,
rupture, laceration, avulsion)
– sharp trauma (stab, shot injury)
Renal injuriesRenal injuriesRenal injuriesRenal injuries
Diagnostics: – trauma in history– haematuria– blood in the peritoneal fluid or in the
retroperitoneum– X-ray (excretory urography) – US– exploratory laparatomy
Diagnostics: – trauma in history– haematuria– blood in the peritoneal fluid or in the
retroperitoneum– X-ray (excretory urography) – US– exploratory laparatomy
Renal injuries Renal injuries retroperitoneal hematomaretroperitoneal hematoma
Renal injuries Renal injuries retroperitoneal hematomaretroperitoneal hematoma
Renal injuries Renal injuries retroperitoneal hematomaretroperitoneal hematoma
Renal injuries Renal injuries retroperitoneal hematomaretroperitoneal hematoma
Renal injuriesRenal injuriesShot injuryShot injury
Renal injuriesRenal injuriesShot injuryShot injury
Renal injuriesRenal injuriesRenal injuriesRenal injuries
Therapy:–suturing (supf. rupture)–hematoma-drainage?–nephrectomy (partial; total)
Therapy:–suturing (supf. rupture)–hematoma-drainage?–nephrectomy (partial; total)
Partial nephrectomyPartial nephrectomyPartial nephrectomyPartial nephrectomy
Renal injuriesRenal injuriesRenal injuriesRenal injuries
Therapy:–suturing (supf. rupture)–hematoma-drainage?–nephrectomy (partial; total)
Therapy:–suturing (supf. rupture)–hematoma-drainage?–nephrectomy (partial; total)
Renal injuriesRenal injuriesRupture of the kidneyRupture of the kidneyRenal injuriesRenal injuries
Rupture of the kidneyRupture of the kidney
Renal injuriesRenal injuriesShot injuryShot injury
Renal injuriesRenal injuriesShot injuryShot injury
Surgery of the UreterSurgery of the UreterSurgery of the UreterSurgery of the Ureter
Surgical anatomySurgical anatomySurgical anatomySurgical anatomySurgical Diseases of the UreterSurgical Diseases of the UreterSurgical Diseases of the UreterSurgical Diseases of the Ureter
Hydroureter (hydronephros)Hydroureter (hydronephros)
Ectopic ureterEctopic ureter
UreterUreter--calculuscalculus
UreterUreter--injuriesinjuries
Hydroureter (hydronephros)Hydroureter (hydronephros)
Ectopic ureterEctopic ureter
UreterUreter--calculuscalculus
UreterUreter--injuriesinjuries
Surgical Diseases of the UreterSurgical Diseases of the UreterSurgical Diseases of the UreterSurgical Diseases of the Ureter
Hydroureter (hydronephros)Hydroureter (hydronephros)
Ectopic ureterEctopic ureter
UreterUreter--calculuscalculus
UreterUreter--injuriesinjuries
Hydroureter (hydronephros)Hydroureter (hydronephros)
Ectopic ureterEctopic ureter
UreterUreter--calculuscalculus
UreterUreter--injuriesinjuries
Ectopic ureterEctopic ureterEctopic ureterEctopic ureter
Incidence: abnormal opening of the ureter(urethra, vagina)
– uni- or bilateral
– extra- (cats) or intramural (dogs)– associated with other disorders
(renal hypoplasia, ureterocele, ureter-dilatation, hydronephrosis etc.)
– breed predisposition (labrador, golden, husky, west highland white terrier, foxterrier, sky terrier, poodle)
Incidence: abnormal opening of the ureter(urethra, vagina)
– uni- or bilateral
– extra- (cats) or intramural (dogs)– associated with other disorders
(renal hypoplasia, ureterocele, ureter-dilatation, hydronephrosis etc.)
– breed predisposition (labrador, golden, husky, west highland white terrier, foxterrier, sky terrier, poodle)
Ectopic ureterEctopic ureterEctopic ureterEctopic ureterDiagnosis:
– urinary incontinence unilateral ectopia: normal urination and incontinence bilateral ectopia: complete and constant incontinence (sometimes signs of urina in males, rarely in females)
– urinary infection– X-ray: excretory urography + pneumo-
cystography; vaginography– Cystoscopy
Types: – Intramural or extramural
Diagnosis:– urinary incontinence
unilateral ectopia: normal urination and incontinence bilateral ectopia: complete and constant incontinence (sometimes signs of urina in males, rarely in females)
– urinary infection– X-ray: excretory urography + pneumo-
cystography; vaginography– Cystoscopy
Types: – Intramural or extramural
Ectopic ureterEctopic ureterExcretory urographyExcretory urographyEctopic ureterEctopic ureter
Excretory urographyExcretory urography
Ectopic ureterEctopic ureterEctopic ureterEctopic ureterDiagnostics:
– urinary incontinence unilateral ectopia: normal urination and incontinence bilateral ectopia: complete and constant incontinence (sometimes signs of urina in males, rarely in females)
– signs of urinary infection– X-ray: excretory urography + pneumo-
cystography; vaginography– cystoscopy
Types: – Intramural or extramural
Diagnostics:– urinary incontinence
unilateral ectopia: normal urination and incontinence bilateral ectopia: complete and constant incontinence (sometimes signs of urina in males, rarely in females)
– signs of urinary infection– X-ray: excretory urography + pneumo-
cystography; vaginography– cystoscopy
Types: – Intramural or extramural
Ectopic ureterEctopic ureterPositive contrast vaginographyPositive contrast vaginography
Ectopic ureterEctopic ureterPositive contrast vaginographyPositive contrast vaginography
Ectopic ureterEctopic ureterEctopic ureterEctopic ureterDiagnostics:
– urinary incontinence unilateral ectopia: normal urination and incontinence bilateral ectopia: complete and constant incontinence (sometimes signs of urina in males, rarely in females)
– signs of urinary infection– X-ray: excretory urography + pneumo-
cystography; vaginography– Cystoscopy
Types: – Intramural or extramural
Diagnostics:– urinary incontinence
unilateral ectopia: normal urination and incontinence bilateral ectopia: complete and constant incontinence (sometimes signs of urina in males, rarely in females)
– signs of urinary infection– X-ray: excretory urography + pneumo-
cystography; vaginography– Cystoscopy
Types: – Intramural or extramural
EctopicEctopic ureterureterCystoscopyCystoscopy
EctopicEctopic ureterureterCystoscopyCystoscopy
UreterUreter--orificeorifice
urethraurethra
Intramural Intramural
Ectopic ureterEctopic ureterEctopic ureterEctopic ureter
Urinary bladder
Ectopic ureter
ExtramuralExtramuralEctopicEctopic ureterureterEctopicEctopic ureterureter
Therapy:– trigone reconstruction (intramural)– „ureteroneocystostomy” (extramural)
– nephro-ureterectomy (hydroureter-hydronephrosis)
Therapy:– trigone reconstruction (intramural)– „ureteroneocystostomy” (extramural)
– nephro-ureterectomy (hydroureter-hydronephrosis)
Ectopic ureterEctopic ureterTTrigonerigone--rekonstructionrekonstruction
Ectopic ureterEctopic ureterTTrigonerigone--rekonstructionrekonstruction
EctopicEctopic ureterureterTrigone reconstruction (intramural)
EctopicEctopic ureterureterTrigone reconstruction (intramural)
EctopicEctopic ureterureterEctopicEctopic ureterureter
Therapy:– trigone reconstruction (intramural)– „ureteroneocystostomy” (extramural)
– nephro-ureterectomy (hydroureter-hydronephrosis)
Therapy:– trigone reconstruction (intramural)– „ureteroneocystostomy” (extramural)
– nephro-ureterectomy (hydroureter-hydronephrosis)
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
ureter
ureter
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
ureterUrinary bladder
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
ureter
Urinary bladder
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
Ectopic ureterEctopic ureterUreteroneocystostomyUreteroneocystostomy
ureter
Urinary bladder
EctopicEctopic ureterureterEctopicEctopic ureterureter
Therapy:– trigone reconstruction (intramural)– „ureteroneocystostomy” (extramural)
– nephro-ureterectomy (hydroureter-hydronephrosis)
Therapy:– trigone reconstruction (intramural)– „ureteroneocystostomy” (extramural)
– nephro-ureterectomy (hydroureter-hydronephrosis)
Ectopic ureterEctopic ureterExcretory urographyExcretory urographyEctopic ureterEctopic ureter
Excretory urographyExcretory urography
Ectopic ureterEctopic ureterNephroNephro--ureterectomyureterectomyEctopic ureterEctopic ureter
NephroNephro--ureterectomyureterectomyEctopic ureterEctopic ureter
NephroNephro--ureterectomyureterectomyEctopic ureterEctopic ureter
NephroNephro--ureterectomyureterectomy
Surgical Diseases of the UreterSurgical Diseases of the UreterSurgical Diseases of the UreterSurgical Diseases of the Ureter
Hydroureter (hydronephros)Hydroureter (hydronephros)
Ectopic ureterEctopic ureter
UreterUreter--calculuscalculus
UreterUreter--injuriesinjuries
Hydroureter (hydronephros)Hydroureter (hydronephros)
Ectopic ureterEctopic ureter
UreterUreter--calculuscalculus
UreterUreter--injuriesinjuries
UreterUreter--calculuscalculusUreterUreter--calculuscalculus associated with nephrolythiasis (50% coincidence)
Diagnostics:– In dogs and cats– Struvite, oxalate– in unilateral cases: asymptomatic– abdominal pain– X-ray / excretory urography– US– consecutive hydroureter/hydronephros
associated with nephrolythiasis (50% coincidence)
Diagnostics:– In dogs and cats– Struvite, oxalate– in unilateral cases: asymptomatic– abdominal pain– X-ray / excretory urography– US– consecutive hydroureter/hydronephros
UreterUreter--calculuscalculusExcretory urographyExcretory urographyUreterUreter--calculuscalculusExcretory urographyExcretory urography
UreterUreter--calculuscalculusExcretory urographyExcretory urographyUreterUreter--calculuscalculusExcretory urographyExcretory urography
UreterUreter--calculuscalculusUreterUreter--calculuscalculus
Therapy:–ureterotomy–ureter-resection / anastomosis–nephro-ureterectomy
Therapy:–ureterotomy–ureter-resection / anastomosis–nephro-ureterectomy
UreterUreter--calculuscalculusUreterotomy Ureterotomy -- Ureter calculusUreter calculus
UreterUreter--calculuscalculusUreterotomy Ureterotomy -- Ureter calculusUreter calculus
UreterUreter--calculuscalculusUreterotomy Ureterotomy -- Ureter calculusUreter calculus
UreterUreter--calculuscalculusUreterotomy Ureterotomy -- Ureter calculusUreter calculus
UreterUreter--calculuscalculusUreterotomy Ureterotomy -- Ureter calculusUreter calculus
UreterUreter--calculuscalculusUreterotomy Ureterotomy -- Ureter calculusUreter calculus
Ureter calculusUreter calculusUreterUreter--stenting („pigtail” stenting („pigtail” catheter)catheter)
Ureter calculusUreter calculusUreterUreter--stenting („pigtail” stenting („pigtail” catheter)catheter) UreterUreter--calculuscalculusUreterUreter--calculuscalculus
Therapy:–ureterotomy–ureter-resection / anastomosis–nephro-ureterectomy
Therapy:–ureterotomy–ureter-resection / anastomosis–nephro-ureterectomy
UreterUreter--anastomosisanastomosisUreterUreter--anastomosisanastomosis UreterUreter--calculuscalculusUreterUreter--calculuscalculus
Therapy:–ureterotomy–ureter-resection / anastomosis–nephro-ureterectomy
Therapy:–ureterotomy–ureter-resection / anastomosis–nephro-ureterectomy
UreterUreter--calculuscalculusExcretory urographyExcretory urographyUreterUreter--calculuscalculusExcretory urographyExcretory urography
UreterUreter--calculuscalculusExcretory urographyExcretory urographyUreterUreter--calculuscalculusExcretory urographyExcretory urography
UreterUreter--calculuscalculusNephroNephro--ureterectomyureterectomyUreterUreter--calculuscalculus
NephroNephro--ureterectomyureterectomyUreterUreter--calculuscalculus
NephroNephro--ureterectomyureterectomyUreterUreter--calculuscalculus
NephroNephro--ureterectomyureterectomy
UreterUreter--calculuscalculusNephroNephro--ureterectomyureterectomyUreterUreter--calculuscalculus
NephroNephro--ureterectomyureterectomy Surgical Diseases of the UreterSurgical Diseases of the UreterSurgical Diseases of the UreterSurgical Diseases of the Ureter
Hydroureter (hydronephros)Hydroureter (hydronephros)
Ectopic ureterEctopic ureter
UreterUreter--calculuscalculus
UreterUreter--injuriesinjuries
Hydroureter (hydronephros)Hydroureter (hydronephros)
Ectopic ureterEctopic ureter
UreterUreter--calculuscalculus
UreterUreter--injuriesinjuries
UreterUreter--injuriesinjuriesUreterUreter--injuriesinjuries
Incidence/Aetiology– rare– iatrogenic (OE/OHE)– blunt abdominal trauma
Incidence/Aetiology– rare– iatrogenic (OE/OHE)– blunt abdominal trauma
UreterUreter--injuriesinjuriesUreterUreter--injuriesinjuries
Diagnosis:– unilateral or bilateral
– signs may develop days after injury– abdominal pain – uremia
– uroperitoneum (diagnostic puncture: Creat, K+ )
– uroretroperitoneum– X-ray: excretory urography (contrast spot)
– US (free fluid)
Diagnosis:– unilateral or bilateral
– signs may develop days after injury– abdominal pain – uremia
– uroperitoneum (diagnostic puncture: Creat, K+ )
– uroretroperitoneum– X-ray: excretory urography (contrast spot)
– US (free fluid)
UreterUreter--injuriesinjuriesTorn uretersTorn ureters
UreterUreter--injuriesinjuriesTorn uretersTorn ureters
UreterUreter--injuriesinjuriesTorn uretersTorn ureters
UreterUreter--injuriesinjuriesTorn uretersTorn ureters
UreterUreter--injuriesinjuriesTorn uretersTorn ureters
UreterUreter--injuriesinjuriesTorn uretersTorn ureters UreterUreter--injuriesinjuriesUreterUreter--injuriesinjuries
Therapy:–ureter resection / anastomosis
–ureteroneocystostomy
–nephro-ureterectomy
Therapy:–ureter resection / anastomosis
–ureteroneocystostomy
–nephro-ureterectomy
UreterUreter--injuriesinjuriesUreterUreter--anastomosisanastomosisUreterUreter--injuriesinjuries
UreterUreter--anastomosisanastomosis UreterUreter--injuriesinjuriesUreterUreter--injuriesinjuries
Therapy:–ureter resection / anastomosis
–ureteroneocystostomy
–nephro-ureterectomy
Therapy:–ureter resection / anastomosis
–ureteroneocystostomy
–nephro-ureterectomy