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Small animal surgery I > Surgery of the urethra > Flashcards

Surgery of the urethra Flashcards

1
Q

What is hypospadias? How do you treat it?

A
  • Incomplete formation of the penile urethra
  • Causes urination out of urethral orifice in abnormal location
  • Nothing is done–congenital defect
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2
Q

What is a urethral prolapse?

A

Protrusion of urethra mucosa through orifice

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3
Q

What are the predisposing causes/etiologies for urethral prolapse?

A
  • Young, male brachycephalic dogs
  • Etiology is unknown
    • Sexual excitement
    • Dyspnea
    • Infection
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4
Q

What are the clinical signs of urethral prolaspe?

A
  • Bleeding from prepuce
  • Licking
  • Red-purple mass
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5
Q

What is the treatment for urethral prolapse if the animal is asymptomatic?

A
  • Reduce with aid of large catheter
  • Place purse string suture
  • Leave for 5 days
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6
Q

What are the symptoms of urethral prolapse that would require more aggressive treatment?

A
  • Excessive bleeding
  • Ulcerative mucosa
  • Necrosis
  • Failure of conservative management
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7
Q

What are the options for surgical treatment of urethral prolapse? What is the adjunct treatment?

A
  • Resection and anastomosis
  • Urethropexy
  • Adjunct treatment = castration + surgical correction of airway
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8
Q

Describe the procedure for resection and anastomosis of a urethral prolapse

A
  • Place catheter
  • Penile tourniquet (keeps penis extruded, controls bleeding)
  • 180o incision (prevents mucosal retraction)
  • Suture and complete resection
  • Stay sutures in urethral mucosa
  • Place 2 straight needles full thickness through urethra (prevents retraction)
  • Transect and suture
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9
Q

Describe the procedure for a urethropexy as treatment for urethral prolapse

A
  • Resect urethral mucosa
  • Place groove director into urethra
  • Place 3 full thickness sutures through penile wall and urethra
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10
Q

What are the clinical signs of urethral trauma?

A
  • Hematuria
  • Stranguria
  • Subcutaneous or abdominal fluid accumulation
  • Signs of azotemia
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11
Q

How do you diagnose urethral trauma?

A

Positive contrast urethrogram (very diagnostic)

Plain rads are NOT diagnostic

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12
Q

What is the treatment for small/incomplete urethral lacerations?

A
  • Will heal with urinary diversion via urethral catheter or cystostomy tube
    • Duration of catheterization depends on severity–minimum of 3 weeks
    • Catheterization increases risk of stricture formation
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13
Q

What is the treatment for complete rupture of the urethra?

A

Anastomosis or repair with urinary diversion

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14
Q

What causes urethral obstruction in dogs and cats? Which are the most common?

A
  • Mucus plugs
  • Crystals/stones
  • Neoplasia
  • Strictures
  • Most common cause in male dogs = calculi
  • Most common cause in male cats = mucus plugs/crystals
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15
Q

T/F: Incidence of urethral obstruction has decreased due to changes in diets

A

TRUE

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16
Q

Where is urethral obstruction most common?

A
  • Male dogs = ischial arch or just caudal to os penis
  • Male cats = distal 1/3 of urethra
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17
Q

How do you diagnose urethral obstruction?

A
  • Plain rads
    • Radiopaque calculi
    • Large distended bladder
  • Ultrasound
  • Contrast urethrography
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18
Q

What are the 7 goals of urethral obstruction treatment?

A
  1. Treat the patient first and deal with obstruction afterwards
  2. Renal fx preservation
  3. Uremia/electrolytes (must give fluids–BUN, CREA elevated)
  4. Treat UTI
  5. Prevent recurrence
  6. Catheter and fluids
  7. Temporarily relieve obstruction
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19
Q

What are the 3 procedures for temporarily relieving urethral obstructions?

A
  • Retrograde hydropropulsion
  • Feline urethral catheterization
  • Surgical removal of calculi
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20
Q

Describe the process of retrograde hydropropulsion

A
  • Palpate stone
  • Compress urethra
  • Pass catheter
  • Pinch off orifice
  • Inject saline
  • Distend urethra
  • Relieve compression
21
Q

What are the 3 types of catheters used in feline urethral catheterization?

A
  • Tomcat catheter
  • Slippery Sam
  • Red rubber catheter
22
Q

What are the options for surgical removal of urethral calculi?

A
  • Cystotomy after hydropropulsion
  • Urethrotomy if hydropropulsion unsuccessful
  • Often cystotomy combined with urethrotomy is performed
  • Urethrostomy–to prevent recurrence if medical prevention is not possible
23
Q

What are the indications for a urethrotomy in a dog?

A

Calculi that cannot be hydropropulsed

(Cystotomy is preferred)

24
Q

Where (and why) is a urethrotomy performed in canines?

A
  • Prescrotal
    • Common obstruction
    • Superficial
    • Less cavernous tisue
25
Q

What are the options for closure following a urethrotomy?

A
  • 4/0 or 5/0 monofilament absorbable (very fine suture)
  • Second intention
    • Less risk of stricture
    • Profuse hemorrhage
    • Hospitalization (monitoring)
26
Q

Why is a perineal urethrotomy less preferred in the canine?

A
  • Difficult procedure (urethra deeper)
  • Increased risk of infection
  • Usually suture urethrotomy incision
27
Q

Why is a perineal urethrostomy less preferred in canines?

A
  • More tension
  • More cavernous tissue
  • More urine scald
  • More UTIs
  • Stenosis
28
Q

What is a urethrostomy?

A

Surgical formation of a permanent opening of the urethra at a new site

29
Q

Where is the preferred location for a urethrostomy in the canine? Why?

A
  • Scrotal
    • More superficial
    • Relatively wide urethra
    • Less hemorrhage
    • Less urine scald (compared to perineal and pre-scrotal)
30
Q

Where is the preferred location for a urethrostomy in the feline?

A

Perineal

31
Q

What structures should be draped in the surgical field during a scrotal urethrostomy?

A

Abdomen, scrotum, prepuce

32
Q

How long should the urethral incision for a scrotal urethrostomy be?

A

Midline incision in urethra should be 2.5-4cm long

(5-8x urethral diameter)

33
Q

What is the most appropriate suturing method for a scrotal urethrostomy?

A
  • Suture laterally to prevent impingement on urethra
  • Make midline incision in urethra 2.5-4cm long
  • Caudal extent where urethra turns dorsally into ischial arch
  • Suture with 4/0 or 5/0 absorbable monofilament
  • Accurately appose skin and mucosa
    • Suture urethral mucosa to underlying fibrous tissue to the skin (tighter closure, minimizes hemorrhage)
  • Take bites at edge of cavernous tissue (better strength, less hemorrhage)
34
Q

What are the possible complications of a scrotal urethrostomy?

A
  • Hemorrhage
  • Dehiscence
  • Urine scald
  • Stricture
  • UTI
35
Q

What is a disadvantage of canine prescrotal urethrostomy?

A

Higher incidence of urine scald

36
Q

When is a perineal urethrostomy in a cat indicated?

A
  • Frequent obstructions
  • Strictures
  • Trauma
37
Q

What are the goals of a perineal urethrostomy in cats?

A
  • Adequate mobilization of urethra
  • Preserve urethral branches of the internal pudendal nerve with minimal dorsal dissection
  • Creation of a wide urethral orifice
38
Q

What gland/area of the urethra do you dissect to when performing a perineal urethrostomy in a cat?

A
  • Tranect ischiocavernosus and ischiourethralis muscles from their insertion on the ischium
  • Excise retractor penis muscle dorsally
  • Dissect to level of BBU gland
  • Incise the urethra on dorsal midline
  • Continue proximal to bulbospongiosus mucle/pelvic urethra
39
Q

How can you check that the urethral orifice is wide enough during a perineal urethrostomy in a cat?

A

Ensure adequate width with mosquito hemostat to hinge

40
Q

What are the complicatios of perineal urethrostomy in felines?

A
  • Hemorrhage
  • UTI
  • Stricture
  • Subcutaneous urine leakage
  • Perineal hernia
  • Urinary incontinence
  • Urethrorectal fistula
41
Q

How can you minimize stricture formation following perineal urethrostomy in a cat?

A
  • Proper surgical technique
  • May be revised with second procedure
  • May require antepubic urethrostomy
42
Q

What can cause subcutaneous urine leakage following a perineal urethrostomy in a cat?

How can you treat it?

A
  • Improper suturing
  • Urethral tear
  • Treat with indwelling 8 French catheter for 5-7 days
43
Q

What is an antepubic urethrostomy and when is it indicated?

A
  • Creation of a urethrostomy on the ventral body wall cranial to the pubis
  • Indications
    • Recurrent pelvic urethral obstruction
    • Failed perineal urethrostomy that cannot be revised
44
Q

What are the possible complications of an antepubic urethrostomy?

A
  • Urine scalding
  • UTI
  • Incontinence
45
Q

What are the causes of urethral strictures?

A
  • Usually caused by trauma
    • Urethral sx
    • Uroliths
    • Iatrogenic from catheterization
    • Healing after minor trauma
46
Q

When do patients show clinical signs of urethral strictures?

A

>60% narrowing

47
Q

How do you diagnose urethral strictures?

A
  • Urethrogram
  • Cystoscopy
48
Q

How are urethral strictures treated?

A
  • Treat if showing clinical signs
  • Urethral dilators
  • Balloon dilation
  • Resection and anastomosis
  • Proximal urethrostomy

Small animal surgery I (25 decks)

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