Ch 117 urethra Flashcards
List the layers of the urethra
Mucosa (transitional > squamous epithelium)
Submucosa
Muscularis
Describe the urethra muscularis in the male and female dogs and cat
Male dog:
- Inner longitudinal smooth surrounded by outer circumferential striated
- Striated muscle is the distal 2/3rds of the urethra
- Striated mostly Type II fast twitch, some Type I slow twitch
Male cats:
- 3 layers of smooth muscle - inner longitudinal, middle circumferential, outer longitudinal
Female dog:
- Three smooth muscle layers as male cats
- striated muscle fibers in the distal third > Smooth muscle essentially absent in terminal urethra
- Prominent sphincter of striated muscle at external urethral orifice
Female cat:
- Significantly more smooth muscle and significantly less striated urethral sphincter than female dog
striated muscle > innervated by pudendal n.
Anatomy
Male
- divided anatomically into pelvic and penile components
- subdivided into preprostatic and prostatic
- penile component begins at the ischial arch and is surrounded by the corpus spongiosum
- Gonadectomy or age at time of gonadectomy does not affect urethral diameter in mature male cats
female
- urethra of female dogs contains significantly more collagen and less muscle than male dogs
- increase in the proportion of collagen and reduction in muscle in the urethra of gonadectomized female dogs, compared with intact dogs
- findings suggest that steroidal hormones may influence the morphology of the canine urethra
What is the urethral diameter of male cats at the level of the bulbourethral glands compared to the penile urethra
Bulbourethral gland 1.3mm
Penile urethra 0.7mm
Initial management of patients with suspected urethral obstruction should include:
- evaluation of hemodynamic status,
- correction of metabolic derangements,
- urinary diversion
- postobstructive diuresis (once unblocked)
What is the theorised mechanism of hypothermia in cats with urethral obstruction?
Reduction in the thermoregulatory set point in the hypothalamus secondary to uraemia
Or secondary to volume depletion and shock
What is the time frame for renal decompensation and death in aminals with complete urethral obstruction?
Renal decompensation within 24hr
Death 3-6d
What fluid is most efficient for correcting electrolyte derangement with urethral obstruction?
LRS
alkalinizing effect helps to drive potassium ions intracellularly
List options and mode of action of each option for the treatment of hyperkalaemia
10% Ca Gluconate
- Increases threshold for cardiac myocyte depolarisation. 0.5-1.5ml/kg IV over 5-10 min, last 30-60min
IV dextrose +/- regular insulin
- Drived K intracellularly by cotransport. Lasts 2-4hr
Na Bicarb
- Enables H ions to move extracellularly in exchange for K. Only used if severe acidosis
ECG changes
- spiked T-waves
- depressed R-waves,
- prolonged QRS and PR intervals and ST segment depression,
- smaller and wider P-waves with a prolonged QT interval,
- atrial standstill,
- eventually wide QRS complexes and ventricular arrhythmias
unblock
catheter are unsuccessful:
- retrograde urohydropulsion under general anesthesia
- improved by lubricating agents, topical anesthesia, or coccygeal epidural
- bladder decompression can be maintained by intermittent cystocentesis
- placement of a cystostomy tube (minimally invasive inguinal approach)
- a guide wire can be passed through the body wall and antegrade out the urethra
diagnosis
RADS
- radiopaque urinary calculi,
- Positive-contrast retrograde urethrography (best for suspected tear)
- retrograde vaginourethrocystography in females
- Negative (air)-contrast radiography is contraindicated with suspected lower urinary tract trauma
- Ideally, fluoroscopy should be performed
- gradual withdrawal of the catheter or use of a voiding cystogram
- cannot be catheterized, a normograde urethrocystogram
ultrasound limited, CT/MRI not well described
Cystoscope
- evaluation and treatment of a variety of lower urinary tract diseases
List the critical factors which effect urethral healing
- Mucosal continuity
- Urine extravasation
If a strip of mucosa is left intact and urine is diverted, the urethral mucosa can regenerate within 7 days
exposure of submucosal tissue to urine may promote formation of scar tissue, reducing the elastic qualities
Urethral Healing
partial
- Conservative therapy is indicated
- mucosal continuity and the flow of urine is diverted
complete
- Primary surgical repair or permanent urinary diversion is indicated
- urethral mucosa may retract, and fibrotic tissue may ultimately bridge the gap and obstruct
- ventral midline celiotomy/pubic osteotomy followed by antegrade (through the bladder) or retrograde urethral catheterization may be required to identify the distal end of the proximal urethral segment
- Diversion (cystostomy tube or indwelling urethral catheter) is recommended for 3 to 5 days to minimize the risk for urethral stricture
- size 4-0 or 5-0 USP
- tensile strength of poliglecaprone 25 (Monocryl; Ethicon) is lost at a relatively rapid rate when immersed in a container of urine
- presence of an indwelling catheter can promote inflammation and ascending infection
- Some reduction in urethral luminal diameter at the site of surgical repair is anticipated, regardless of whether or not a catheter is left in place after surgery.
How much narrowing of the urethral lumen occurs before clinical signs occur?
60%
Urethrotomy
- commonly indicated for removal of calculi
- if can be dislodged and flushed back into the bladder, cystotomy is preferable to urethrotomy
- DOGS prescrotal region, because calculi most often lodge at the base of the os penis
- optimal location for urethrotomy because of the superficial position of the urethra and paucity of surrounding cavernous tissue
- Perineal and prepubic urethrotomy can be performed
- minimally invasive perineal urethrotomy can be performed under simultaneous ultrasonographic and fluoroscopic guidance > for insertion of a scope
- Hemorrhage, especially associated with urination, is the most common complication
- Urethral stricture is an uncommon
Prescrotal Urethrotomy
- prepuce should be irrigated with dilute antiseptic
- Retrograde urethral catheterization is used to facilitate identification of the urethra and determine the level of the obstruction
- 2-cm incision is made on the ventral midline immediately caudal to the os penis
- paired retractor penis muscles are retracted laterally.
- The urethra and surrounding corpus spongiosum is identified as a purple
- Profuse hemorrhage is expected > cotton tip or ellulose surgical spears
- Calculi are removed, and the urethral catheter is advanced proximally into the bladder.
- A cystotomy can be performed
- The urethra is flushed antegrade and retrograde
alternative
- modification of this technique is urethrotomy through the glans penis
closure?
- second intention healing, urination will occur from the urethral incision for 10 to 14 days until the wound heals (petroleum-based jelly may reduce urine scalding and scrotal dermatitis)
- if haemorrhage profuse may need closure
- primary closure 4/0
List the options for a urethrostomy
Scrotal
Perineal
Transpelvic
Subpubic
Prepubic
How long should the incision in the urethra be for a urethrostomy?
How much contraction is expected during healing?
2.5-4cm long (approx 5-8x urethral diameter)
Will contract by 1/3-1/2 during healing
stoma will contract by one-third to one-half of its original length
Hows does a continuous suture in a scrotal urethrostomy effect post-op haemorrhage?
Decreases time of active haemorrhage from 4.2d to 0.2d
Scrotal Urethrostomy in Male Dogs
- preferred over perineal urethrostomy because the urethra is relatively superficial and wide at the level of the scrotum, and less hemorrhage occurs
- urethral mucosa is incredibly thin and somewhat fragile, and tissue handling must be gentle and precise
- Apposition can often be improved by using a two-step process during suture placement
- A urinary catheter is placed
- sutures are placed from the tunica albuginea to the subcutaneous tissue on either side of the intended urethrostomy site to maintain the penis and urethra in a superficial position
- incision is centered on the urethral midline
- Use of magnification may be beneficial,
- Elizabethan collar should be maintained for 2 to 3 week
- Bleeding associated with urination occurs for an average of 3 to 5 days after urethrostomy and is usually self-limiting.
complications
- haemorrhage
- Intermittent urine scald,
- recurrent urinary tract infections,
- recurrent obstruction from calculi
- stricture (uncommon)
each occurred in 10% of dogs
What is the name of the standard cat PU technique?
Wilson and Harrison technique
What ventral structures need to be transected during a cat PU?
Ventral penile ligament
Attachment of ischiocavernosus muscles
To what level is the penis freed and the urethra incised in a cat PU?
To the bulbourethral glands
PU sx
- ischial attachments are sharply transected with scissors or electrocautery or detached with a periosteal elevator.
- retractor penis muscle (or its remnant in castrated males) is identified on the dorsal aspect of the penis and excised
- Halsted mosquito forceps > new stoma should easily accommodate
- Precise and tension-free apposition, 4/0 or 5/0
- dorsal sutures are critical to maximize stoma size and prevent urine leakage
- STUDY: No significant differences in postoperative complications were reported when closure was performed with a simple continuous pattern
- distal extent a washboard to the skin
- postoperative period shredded paper + petroleum jelly is applied to the peristomal region
- Perineal urethrostomy can be easily performed in dorsal recumbency
What is the expected outcome after PU surgery?
12.8-25% early complications (haemorrhage, stricture, extravasation)
- Strictures: secondary to excessive tension at the point of the bulbourethral glands
- extravasation typically results from imprecise urethrocutaneous apposition (can cause inflamm fibrosis, necrosis , slough)
Long-term complications 28% (UTI, recurrent FLUTD)
- attributed to ascending bacterial migration because of urethral shortening
- risk for infection is not increased in normal cats > indicating underlying uropathy
Good long term outcome (88%) but most will require ongoing management of underlying uropathy
What muscles are elevated in the approach for a transpelvic urethrostomy?
Gracilis
External obturator
Transpelvic Urethrostomy in Male Cats
- employs a caudal ischial ostectomy to allow access to, and ventral opening of, the pelvic urethra 15 to 18 mm cranial to the bulbourethral glands
- useful for revision of failed PU
- ventral approach reduces the risk for iatrogenic damage to the dorsal innervation
- Bone rongeurs are used to remove a section of the caudal ischium, 12 mm in length and 10 mm in width
outcome TU
- minor long-term complications were noted, including recurrent signs of FLUTD in 2 cases and peristomal or pelvic limb urine staining
- low incidence of stricture was attributed to the fact that the stoma was positioned in the wider pelvic urethra
What muscles require elevation in the approach for a subpubic urethrostomy?
Gracilis
Adductor
prepubic tendon is incised
Subpubic Urethrostomy in Male Cats
- pubic osteotomy and creation of a pubic flap to provide access to the postprostatic urethra
- urethra tunneled subcutaneously to form a stoma in a subpubic location, caudal to the inguinal fat pads
- anecdotally is associated with less complications than prepubic
- T-shaped flap osteotomy
- approximately 3 cm caudal to the pubic brim. The urethra is tunneled through the subcutaneous tissue, exteriorized
Prepubic Urethrostomy
- involves creation of a stoma on the ventral midline immediately cranial to the brim of the pubis
- In male dogs the stoma can be created in a parapreputial location or potentially into the preputial cavity
- proximal urethra is identified and isolated, taking care to avoid traumatizing associated innervation and vascular supply
- preserving the maximal amount of normal urethra available to optimize continence > close to vagina or distal to prostate
- the urethra can be exited through a separate paramedian stab incision
- urethra is spatulated with a 5- to 10-mm incision
- continence may be maintained if the sphincter and innervation are preserved
Which urethrostomy has the highest rate or morbidity and complications?
Prepubic
- 6/16 cats incontinent (37%)
- Significant peristomal skin irritation
- Stricture, kinking or compression or urethra
- recurrent UTI
List options for reinforcement of a tenuous urethral anastomosis
Rectus abdominus flap
Internal obturator flap
Omentum
What is the prognosis after urethral resection and anastomosis?
Guarded - Some degree of stenosis is expected
What is the most important factor in minimising stenosis after a urethral anastomosis?
Urinary diversion - either via u-cath or tube cystostomy
Urethral Anastomosis
- indications: trauma, stricture exicision
- access depends on locations i.e celiotomy, eplic osteotomy etc
- suture is placed in the bladder apex, and the bladder is retracted cranially to provide access to the urethra.
- use catheters
- minimize the risk for neurogenic or vascular trauma
- ensuring that both mucosa and submucosa are included in each bite.
- Preplacement of sutures, particularly on the dorsal surface
- reinforce R&A is concerned
What is hypospadia? What breed is overrepresented?
Failure of the fusion of the urogenital folds resulting in incomplete formation of the penile urethra
Bostron Terriers overrepresented
Tx hypospadia
- evaluated for concurrent urogenital abnormalities, most commonly cryptorchidism, but also underdevelopment of the testes, scrotum, prepuce, or penis
- urethrostomy proximal to the site is typically recommended.
What is epispadia?
What condition is often seen concurrently?
Failure of fusion of the dorsal penile urethra.
- May occur with concurrent bladder exstrophy (portions of bladder and abdominal wall absent and bladder appears inside-out)
List the 2 broad types of urethral fistulas
Urethrorectal
Urethrocutaneous
List the surgical options for a double urethra
Open surgical removal
Cyanoacrylate and coil embolisation
Urethral Obstruction
- incidence 18% to 58% of male cats with lower urinary tract disease
- uroliths, urethral plugs, neoplasia, granuloma, bladder displacement or herniation, strictures, trauma, prostatic disease, and idiopathic
- dogs: often lodge immediately caudal to the os penis or at the ischial arch
- cats: distal third of the urethra
neoplasia
- trigone of the bladder is most commonly affected, invade the proximal urethra.
- Cystoscopic electrosurgical transurethral resection showed promise for treatment of male dogs with urethral invasion
- because of discouragingly high complication rates and minimal impact on survival times associated with curative-intent therapy, palliative commonly performed
What % of bladder and urethral tumours are malignant in dogs and cats?
97%
What is the reported incontinence rate of dogs and cats after urethral stenting?
26% dogs
50% cats
Urethral Trauma
- iatrogenic catheterization or from external blunt or penetrating trauma
- associated with pubic fracture
- cats: iatrogenic usually postpelvic urethra (78%), external trauma intrapelvic urethra (74%)
- Uroperitoneum or subq cellulitis
- urinary tract injuries were suspected during physical examination in only one-third of animals that were subsequently found to have urinary tract trauma
- Primary anastomoses appeared to carry a reasonable risk for stricture
three main options for treatment:
1. temporary urinary diversion and second intention healing
2. primary repair
3. permanent urinary diversion via urethrostomy or a cystostomy tube
List causes of urethral stricture
Trauma
Obstruction
Inflammation
Malignancy
Iatrogenic surgical
List the treatment options for a urethral stricture
- Urethrostomy (proximal to the affected site)
- Resection and anastomosis
- Balloon dilatation
- Stent
- Urethral replacement (Aortic stent graft, Rectus abdominus axial pattern flap, ileal segment, oral mucosal grafts +/- adipose-derived stem cells and polyglycolic acid scaffold)
What can cause benign mass-like lesions within the urethra?
Proliferative urethritis
Fibroepithelial polyps
What breed are overrepresented for urethral prolapse?
underlying cause?
What are the surgical options?
Recurrence rate?
protrusion of distal urethral mucosa through external urethral orifice
English Bulldogs
unknown, related to abnormal development of the urethra + increased intraabdominal pressure dt labored breathing, dysuria, or sexual excitement
Sx Options:
- Reduction and purse-string
- Urethropexy
- Resection and anastomosis (torniquet, incision is limited to half the urethral circumference to prevent retraction)
Long-term recurrence 57%
39% of dogs demonstrated postoperative hemorrhage
Application of preputial tube-flap urethroplasty to establish a neourethra in a male dog with complications after preputial urethrostomy
Satanyasuwan 2024
A longitudinal flap was raised from the prepuce and anastomosed to the end of the previously cut urethra to create a neourethra and reduce tension at the urethrostomy site.
The dog had excellent symptom scores, and urinated from the prepuce without difficulty in a manner resembling physiological urination.
Surgical treatment of canine urethral prolapse viavia urethropexy or resection and anastomosis
D. Healy 2024
Seventy-nine dogs
63/79 dogs were of brachycephalic breeds
urethropexy (n=44), resection and anastomosis (n=27) and a combined surgical technique (n=8). Minor complications 41 of 79 dogs (51.9%):
urethropexy 19 of 44 (43.2%),
resection and anastomosis 18 of 27 (66.6%)
combined surgical technique four of eight (50%).
Major complications occurred in 23 dogs (29.1%), of which 21 were recurrence (26.6%). Recurrence occurred in 17 of 44 dogs following a urethropexy (38.6%), three of 27 dogs following resection and anastomosis (11.1%) and one of eight dogs treated with a combined surgical technique (12.5%).
RA, we
had 14 dogs with the urethra sutured with a simple interrupted
and 11 dogs with the urethra sutured with a simple continuous
pattern. There was no significant difference
Resection and anastomosis was associated with a lower recurrence rate in comparison to urethropexy
Minor complications and postoperative bleeding were more common and of longer duration following RA but were self-limiting in all patients.
Comparison of urethral length and
orifice diameter in cats undergoing
transpelvic or subpubic urethrostomy
for perineal urethrostomy revision
(cadaveric study)
Sieglinde David 2023
Stenosis is a postoperative complication reported in 12–17% of male cats
In all cats, TPU could be performed following a technically correct PU. The TPU resulted in a 1.5-times longer
residual urethral length than SPU
Relative to the initial urethral length, PU, TPU and SPU resulted in a reduction of 24%, 36% and 56%,
urethral orifice diameter after TPU did not differ from SPU (P = 1.000), and it was not statistically
significantly different between TPU and PU
TPU preserves a
significantly longer urethral length and requires less tissue dissection, the risk of urinary tract infections, urinary
dermatitis and urinary incontinence might be less following TPU than SPU.
idiopathic functional urinary outflow tract obstruction
iFUOTO is a condition in dogs characterized by difficulty urinating and a large amount of residual urine in the bladder, without any obvious physical blockage or clear neurological disorder directly causing these signs at the onset. The term reflects the unknown cause of this functional obstruction
FUOTO is characterized by the absence of these clear neurological deficits at the onset of urinary signs
Dogs with iFUOTO commonly present with stranguria (straining to urinate). Many dogs (45% in this study) also experience overflow urinary incontinence, which is often diagnosed based on the presence of a large bladder after the dog attempts to void. A large postvoid residual volume (PVRV), meaning a significant amount of urine remains in the bladder after urination,
previously referred to as reflex dyssynergia or detrusor urethral dyssynergia (DUD)
iFUOTO is essentially a diagnosis of exclusion, meaning it is considered after ruling out mechanical obstructions and primary acute neurological diseases
Urinary catheterisation of female dogs: a comparison between three
Urinary catheterisation of female dogs: a comparison between three
techniques for catheter placement
AE Tipler 2020
AVJ
Visual with speculum (SPEC), Blind Palpation (BP) and catheterisation with NCD on three sizes of dog
Median times to catheterisation
were 300 s (IQR 261–417 s) with the SPEC method, 420 s
(IQR 253–545 s) with the NCD method and 725 s (574–1032s) with
the BP method. Both SPEC and NCD methods were significantly
faster compared to the BP method
The novel urinary catheterisation device may provide a
simpler method of visualisation of the urethral papilla and may provide
a more sterile way of placing the catheter, although further
investigation is needed to confirm this.
A novel two-catheter method for urethral catheterization improves success rates of urethral catheterization
in female dogs and cats weighing less than ten kilograms
Josephine A. Dornbusch 2023
38 female cats and dogs weighing less than 10 kg were prospectively enrolled
The 2-catheter technique was more successful than the traditional method (60.5% and 34.2%, respectively)
a red rubber catheter (Sovereign feeding tubes; MWI Animal Health; 10-Fr for cats, 18-Fr for dogs) was introduced into the vestibule and advanced cranially until gentle resistance was met at the cervix
MILA foley indwelling urinary catheter (Foley Catheters with wire stylet; MILA International; 5-Fr for cats, 8-Fr for dogs) was passed into the vestibule, directed along ventral midline at approximately a 45-degree angl
Preputial urethrostomy with preservation of the local anatomy in 4 dogs
Thomas Giansetto 2022
The preputial urethrostomy involved anastomosis of
the pelvic urethra with the preputial mucosa after caudal laparotomy, without
dissection of the prepuce or amputation of the penis
None of
the dogs had signs of dysuria, urinary tract infection, or dermatitis immediately
postoperatively. Two dogs showed signs of urinary incontinence from
15 days to 1 month postoperatively, which persisted
50% incontinenece > slight urinary incontinence when the dog was excited.
Dogs 1 and 4 in our
case series showed some signs of urinary incontinence at
the last follow up. Their urethra was transected just caudal
to the prostate
Outcomes and postoperative
complications after transpelvic
urethrostomy used as first-line
surgery in 38 male cats with
obstructive lower urinary
tract disease
Caroline Dumartinet 2022
complications: short term 18% - idiopathic LUTD and stenosis (16%) most common
long term 34% - LUTD, UTI, stenosis
- mortality rate: 5%
- outcome: 91% free of clinical signs at the end of the study
- stomal stenosis → owner dissatisfaction due to number of revisions
- acceptable first-line tx – [no benefit as first line over traditional PU?]
Prazosin administration increases the rate of recurrent
urethral obstruction in cats: 388 cases
David S. Conway 2022
Urethral relaxation has largely been
attempted pharmacologically with medications such
as α1-adrenoceptor antagonists, acepromazine, and
benzodiazepines. Inflammation, thought to be a key
contributor to the pathophysiology of UO, has also
been targeted via systemic NSAID administration
and intravesicular glycosaminoglycan administration.
5,6 However, none of these pharmaceutical strategies
have been shown to be reliable in achieving
reductions in rUO in smaller clinical studies, and a
highly effective method to prevent rUO remains elusive.
Prazosin potential action as a urethral smooth muscle relaxant
302 (78%) cats received prazosin, while 86 (22%) did not
Prazosin administration increased the likelihood of recurrent UO by 14 days;
Modified prepubic urethrostomy with body wall tunneling:
Description of technique and long-term outcome in eight
male cats
Luca Bresciani 2022
body wall tunneling to increase internal urethral sphincter pressure to maintain continence
- resolution of obstruction, creation of patent stoma and long-term continence
Animals: Eight male cats.
Study Design: Short case series.
no intraoperative complications
were reported.
Two cats required surgical revision at
5 and 6 months, respectively, due to a progressive weight gain and accumulation
of abdominal fat around the stoma, causing a partial stomal obstruction
short oblique tunnel within
the rectus abdominis muscle fibers
Comparison of surgical indications
and short- and long-term complications
in 56 cats undergoing perineal,
transpelvic or prepubic urethrostomy
Maheeka Seneviratne 2021
- indications: PU – feline idiopathic cystitis most common; PPU – trauma most common
- urethrostomy technique associated with cause and imaging findings
- complications: overall short-term: 33/55 (60%); long-term 11/30 (36.7%)
- long-term complications more likely with PPU – incontinence ((13.3%) cats with PPU) and dermatitis
- outcome: short-term mortality 5.6%, long-term mortality 13.3% - independent of sx tech
- 93% good QOL overall
- PPU was associated with a higher long-term complication rate of incontinence than PU and TPU
low numbers of cats in the TPU and PPU
groups
Buccal mucosal graft urethroplasty in male cats
with traumatic complete urethral rupture
Wanchart Yippaditr 2022
15 male domestic shorthair cats with traumatic complete urethral rupture
buccal mucosa was harvested, sutured, and formed into a tubule by use of an 8F indwelling catheter as support. This tubular graft was connected to both ruptured ends of the urethra to renew the urinary passage
Given the potential
for inadequate vascularization of the tubular graft,
we used an omentum wrap,
Fourteen cats had complete membranous urethral rupture (section between prostate and penile urethra), whereas the remaining cat had complete prostatic urethra rupture
13 cats recovered well following surgery
Urethrography 2 weeks and 6 months after surgery revealed no stricture or leakage
2 remaining cats developed a urethral stricture and underwent second surgery
1 cat had incontinency
bladder mucosa, and buccal mucosa, buccal mucosa is optimal because of its lower stricture rate and graft shrinkage.
In a previous study involving male cat cadavers, experi mentally induced defects as long as 20% to 30% of the urethral length were able to be apposed without tension
Effect of intraoperative positioning
on postoperative neurological
status in cats after perineal
urethrostomy
Pavel Slunsky
The briskness of the perineal reflex was significantly decreased and the occurrence
of spinal pain significantly increased 24 h after surgery. A parallel with a low-grade positioning-dependent nerve
injury as described in human medicine may be drawn. However, no positioning method was proven to be superior
to the other.
All tested reflexes in the cats in group A were considered
normal 14 days after surgery
10-30% occurance post-op
Clinical outcomes of 28 cats 12–24
months after urethrostomy
Reginaldo P Sousa-Filho 2020
long-term clinical outcomes and quality of life of
cats having undergone perineal urethrostomy (PU) or prepubic urethrostomy (PPU).
The overall
complication rates of PU and PPU were 31.8% and 83.3%, respectively. Recurrent urinary tract infection (UTI) and
urine scald dermatitis were less frequent in PU than in PPU cats (UTI 22.7% vs 66.6%; dermatitis 4.5% vs 83.3%).
Bacteriuria was present in 77.2% and 100% of PU and PPU cats, respectively. Owner satisfaction rates were
excellent in 81.8% of PU and 33.3% of PPU cases.
PPU limited to cases
in which standard techniques for PU cannot be performed, owing to the potential for recurrent complications and
lower owner satisfaction.
Buccal mucosal graft urethroplasty in five male dogs with
penile urethral stricture at the bulbus glandis
Athipot Jareonsuppaperch 2024
correcting penile urethral strictures
at the bulbus glandis using buccal mucosal graft (BMG) urethroplasty in dogs.
Study design: Prospective clinical trial.
Six months postoperative
follow-up was completed for all dogs with repeated positive contrast urethrogram
All dogs were able to urinate normally after catheter
removal
No major complications were encountered
All owners scored the urinary function as excellent
and ranked their satisfaction very high 6 months after the procedure.
Conclusion: Buccal mucosal graft urethroplasty has positive outcomes for
dogs with penile urethral strictures
Tubular grafts often fail due to inadequate graft take, as
they are not circumferentially surrounded by vascularized
tissue, resulting in a relative deficiency in blood supply
on either side of the graft bed despite adequate dorsal
and ventral support.24,34,38 Thus, owing to greater blood
supply, patch grafts provide better outcomes than tubular
grafts.
Based on these reasons, we chose to utilize the
patch graft urethroplasty technique for graft placement
in all dogs in our study.
alternative: stent, balloon dilation > neither great sucess
Management of incontinence following
pre-pubic urethrostomy in a cat using
an artificial urethral sphincter
M. K. Eayrs 2021
An artificial urethral sphincter mechanism,
with subsequent incremental inflation of the cuff 6 weeks later, resulted in complete resolution
of clinical signs, return to normal urinary function and excellent quality of life. The cat was still continent
at 5-year follow-up.
Multicenter evaluation of decompressive cystocentesis
in the treatment of cats with urethral obstruction
Erica L. Reineke 2021
To investigate whether decompressive cystocentesis (DC) safely facilitates
urethral catheterization (UC) in cats with urethral obstruction (UO).
ANIMALS
88 male cats with UO.
Performing DC did not appear to increase the
risk for urine leakage and uroperitoneum when evaluating
the change in total abdominal effusion
DC did not improve time to place the urinary catheter or ease of UC in cats
with UO
good for emergeny if can’t catherise for some reason. i.e. too unstable for GA
Penile urethral resection and anastomosis augmentation
with regional tissue tension relieving technique: A
cadaveric mechanical study and clinical outcome in
two dogs
Judith Bertran 2021
Cadaveric study and two case reports
The augmentation technique improved the tensile properties of penile
RA in normal cadavers and was associated with successful outcomes in two dogs.
Clinical significance: Penile urethral augmentation anastomosis may help
prevent stricture or leakage secondary to tension at the surgical site after
penile urethral RA.
circumferential suturing of tunica albuginea to the anastomosis
Evaluation of urethral orifice crosssection
dimensions following perineal
urethrostomy in male cats
U. Segal 2020
occurrence of urinary obstruction/stricture 5/24 (20%) at mean 92±25d post-op
- estimations of cross-sectional area by size of largest urinary catheter inserted
- significant decrease in urethral orifice cross-sectional area (0.15±0.09mm2) at 12d post-op
- probability of post-op obstruction: immediate CSA ≤8Fr = 44%; >8F – 6%
- recurrence of obstruction in 3/3 cats with immediate CSA 6F
Contraction of the
urethral orifice diameter is expected during the wound healing phase. Post-operative urinary obstruction
is more likely in cases where LUCi < 8Fr.
Retrospective multicentric study comparing durations
of surgery and anesthesia and likelihoods of shortand
long-term complications between cats positioned
in sternal or dorsal recumbency for perineal urethrostomy
Alicia K. Nye 2020
247 client-owned cats
Patient position was not associated with durations of surgery and anesthesia
for PU, even if a concurrent cystotomy was necessary or the patient required
repositioning from sternal to dorsal recumbency. Likewise, patient position
was not associated with the likelihood of short- and long-term complications.
Surgeons who prefer the dorsal position believe it is
more ergonomic for the surgeon, negates the need for
repositioning of the patient from sternal to dorsal re
cumbency
if a cystotomy is also necessary during the
same anesthetic event, minimizes pressure on the di
aphragm
by the abdominal viscera so that breathing
is not compromised, and avoids cranial movement of
the urinary bladder
dorsal recumbency may also
be superior to sternal recumbency for patient posi
tioning
during PU because the sagittal diameter of
the lumbosacral and sacrococcygeal segments of the
vertebral canal is not as reduced
Outcomes following balloon dilation for management
of urethral obstruction secondary to urothelial carcinoma
in dogs: 12 cases (2010–2015)
Sangho Kim 2019
12 client-owned dogs.
RESULTS
Improvement in clinical signs of urethral obstruction was observed after the
initial dilation procedure for 9 of 12 dogs. Urethral obstruction was known
to recur in 5 dogs 48 to 296 days after the initial procedure
Complications
included hematuria, urinary incontinence, and dysuria; these resolved
within a few days after treatment.
relief of urethral obstruction from urothelial carcinoma in most dogs of the
study population
ACVIM concensus statement
