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Urinary tract surgery

image of Urinary tract surgery
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Abstract

Urinary tract surgery can be technically demanding in rabbits due to their relatively small size and unique anatomy. Some techniques, however, such as cystotomy, are relatively common and fairly straightforward procedures. This chapters assesses Anatomy of the urinary tract; Patient assessment and decision-making; Hypercalciuria and urolithiasis; Lower urinary tract disease; Medical management of urinary tract disease; Surgical considerations and specialist equipment; Surgical procedures; and Postoperative care. : Nephrectomy; Cystotomy.

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Figures

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15.1 Post-mortem dissection showing the urinary tract of a rabbit. Notice the left kidney is free of its peritoneal attachment. A = left adrenal gland; B = right adrenal gland; C = left kidney; D = right kidney; E = left renal vessels; F = left ureter; G = right ureter; H = bladder; I = distal colon.
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15.2 Post-mortem dissection showing the retroperitoneal attachment of the kidney (A). It also shows the anatomical position of the kidney in relation to the adrenal gland (B) and ureter (C).
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15.3 Schematic diagram of the upper urinary tract. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.4 Diagrammatic representation of a cross-section through the rabbit unipapillate kidney. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.5 Schematic drawing of the urinary tract of a female rabbit (ventral view); the bladder and urethra have been opened to show the internal structure. The ureters run over the dorsal surface of the bladder and open level with each other into the neck of the bladder. The distal urethra opens into the vagina, approximately half way along the latter at the external urethral orifice. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.10 Right lateral abdominal retrograde double-contrast cystogram in a 5-year-old male rabbit with hypercalciuria (16 ml air instilled via urinary catheter plus 2 ml Omnipaque). Right lateral abdominal radiograph of the same rabbit using intravenous urography (4 ml Omnipaque), which revealed no obvious abnormalities of the kidneys or ureters. Contrast material can be clearly seen delineating both ureters 15 minutes after injection.
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15.11 Transverse section ultrasound examination of the left kidney of a rabbit, showing slight dilation of the renal pelvis and mild mineralization of the renal crest.
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15.12 Ultrasound examination of the urinary bladder of a rabbit, showing a measurable wall thickness of 0.61 cm due to chronic inflammation.
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15.14 Lateral abdominal radiograph showing an abnormal accumulation of radiodense material within the rabbit’s bladder, consistent with hypercalciuria.
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15.15 Ultrasound scan of the urinary bladder of a rabbit with hypercalciuria. Note the large amount of hyperechoic material (with associated acoustic shadow) filling the urinary bladder and proximal urethra. The bladder wall is not obviously thickened in this case.
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15.16 Renal biopsy can be performed by removing a wedge of parenchyma or using a needle. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.17 Post-mortem dissection showing the lateral (paracostal) approach to the kidney. (© John Chitty)
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15.18 Nephrotomy is performed by making a sagittal incision along the greater curvature of the kidney, after atraumatic clamping of the vessels. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.19 Pyelolithotomy is performed by making a longitudinal incision along the proximal ureter. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.20 Ureterotomy to remove calculi. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.21 Urethral catheterization in the female rabbit is straightforward in a sedated animal, with slight elevation of the hindlimbs. Note the perineal scalding in this patient. The rabbit has been placed in sternal recumbency and the hindlimbs elevated by placement of a sandbag under the pelvic area. An absorbent pad has been placed over the sandbag to contain any urine passed around the catheter.
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15.22 Cystotomy in a rabbit to remove excessive accumulation of calcium carbonate crystals. (Courtesy of Elisabetta Mancinelli)
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15.23 Lateral abdominal radiograph of a male rabbit, showing a large urolith lodged in the distal urethra. This was obstructing urine flow and a distended bladder is visible.
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15.24 Diagrammatic representation of the urethrotomy technique. Gentle dissection exposes the body of the penis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of Midline abdominal incision with reflection of the viscera, showing a benign embryonal nephroma in a 3-year-old male neutered Dutch rabbit. The mass was detected on routine clinical examination with no other clinical signs reported by the owner. (© Mikel Sabater)
Midline abdominal incision with reflection of the viscera, showing a benign embryonal nephroma in a 3-year-old male neutered Dutch rabbit. The mass was detected on routine clinical examination with no other clinical signs reported by the owner. (© Mikel Sabater) Midline abdominal incision with reflection of the viscera, showing a benign embryonal nephroma in a 3-year-old male neutered Dutch rabbit. The mass was detected on routine clinical examination with no other clinical signs reported by the owner. (© Mikel Sabater)
Image of Kidney detached by blunt dissection, with vessels and ureter ligated. (© Mikel Sabater)
Kidney detached by blunt dissection, with vessels and ureter ligated. (© Mikel Sabater) Kidney detached by blunt dissection, with vessels and ureter ligated. (© Mikel Sabater)
Image of Exteriorized bladder with stay sutures. An incision has been made to reveal a urolith. (Courtesy of Joanna Hedley)
Exteriorized bladder with stay sutures. An incision has been made to reveal a urolith. (Courtesy of Joanna Hedley) Exteriorized bladder with stay sutures. An incision has been made to reveal a urolith. (Courtesy of Joanna Hedley)
Image of The urolith has been removed revealing the grossly thickened and oedematous mucosal layer of the bladder wall. (Courtesy of Joanna Hedley)
The urolith has been removed revealing the grossly thickened and oedematous mucosal layer of the bladder wall. (Courtesy of Joanna Hedley) The urolith has been removed revealing the grossly thickened and oedematous mucosal layer of the bladder wall. (Courtesy of Joanna Hedley)
Image of (Courtesy of Joanna Hedley)
(Courtesy of Joanna Hedley) (Courtesy of Joanna Hedley)
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