Exam 3 - Perineal Urethrostomy Flashcards
what is the goal of doing a perineal urethrostomy?
eliminate/reduce urethral obstruction in cats with FLUTD
T/F: it is reasonable to do a PU surgery on a blocked tom
false - patient isn’t stabilized!!! surgery is done on stabilized patients
when do we do perineal urethrostomy surgeries?
on male cats!!!!!
use the 3 strike rule typically - recommended on the 3rd obstruction
or if an owner can’t handle a blocked cat at all
what complications are associated with PU surgeries? what causes them?
stricture - caused by too much tension!! usually at the surgical site when penile urethra isn’t freed enough
subcutaneous leakage of urine - you don’t have perfect apposition of the skin & urethral mucosa
hemorrhage
UTIs
incontinence
what is the most common complication seen with PU surgeries? why?
UTIs!!!
male animals originally have a long urethra, but we are shortening it!!! predisposes them to getting an infection!!
how should an animal be prepped for a PU surgery?
wide clipping of the abdomen!! may need to do a concurrent cystotomy
a lot of shaving around the prepuce specifically
what is shown here in this photo for prep of a patient prior to PU surgery? why is it done?
purse string suture is placed into the rectum
prevents fecal material from leaking out & contaminating your surgical field
what positioning of the patient is done for a PU surgery?
can be dorsal or sternal - likely to see it done more commonly in dorsal recumbency
pelvis is tilted up & a roll of gauze or foam is placed under the bottom to tilt it up - legs are pulled towards the head to further elevate the pelvis
what should you do prior to a PU surgery in an intact male cat?
need to castrate them prior to doing the incision to start the PU
where is the incision made for a PU?
around the prepuce, elliptical shape
staying at least 1 cm ventral of the anus!!!
what is the benefit of leaving a urinary catheter in place when doing a PU surgery?
makes feeling the urethra a lot easier
after making the incision around the prepuce when starting a PU surgery, what is the first step?
dissection down towards the urethra is done
after dissection has been done in a PU surgery to get down to the urethra, what is done next?
traction is placed on the penis/prepuce pulling it caudally so you can identify the ischiocavernosus muscles
what do the stars represent in the photo on the left? what do the dashed lines represent in the photo in the middle?
left - origin of ischiocavernosus muscles just off of the ischium & where you cut them!
middle - ventral ligament of the penis, also needs to be cut
what is so important about cutting the ischiocavernosus muscles & ventral ligament of the penis?
you need to free up the penile urethra or else you will cause too much tension & strictures will happen!!
how do you check that you have freed the attachments of the ischiocavernosus & ventral ligaments of the penis when doing a PU surgery?
take a finger and poke on either side of the penis - finger should sink in
if it doesn’t indicates that you need to free it up more
what do the stars represent? what do the “B’s” represent?
stars - ischiocavernosus muscles
Bs - bulbourethral glands
what is the importance of the bulbourethral glands in a PU surgery?
they mark the proximal extent of your dissection & proximal extent of your incision!!
what marks your incision into the urethra in a PU surgery? how do you go about making your incision?
retractor penis muscle is right on midline of the penile urethra marking your incision
need to get the retractor penis muscle out of the way, can transect/dissect
incision is made into the penile urethra using an 11 blade & then switching to tenotomy scissors extended to go between the bulbourethral glands
how big does your incision into the urethra need to be?
big enough to pass the box locks of mosquito hemostats
what are the critical sutures after you have made your urethral incision?
sutures that will connect the skin to the urethral mucosa!!!!
starts at 6pm (closest to the butt hole) - suture about 2mm apart ensuring that you are getting perfect apposition between the skin & mucosa of the proximal portion of the urethra!!!!!
what happens if you get subcutaneous tissue stuck between your skin & urethral mucosa sutures?
you don’t get perfect apposition & this will result in urine leakage into the subcutaneous space!
after your critical sutures are placed, how are the remaining sutures done?
can be simple continuous - these are used as a drain board for urine to drain out of ventrally - not as important as your critical sutires!!!
after your critical sutures & draining board sutures have been placed, what is the next step in a PU surgery?
penis & prepuce are ligated/amputated
