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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
What are the options for closure following a urethrotomy?
* 4/0 or 5/0 monofilament absorbable (very fine suture) * Second intention * Less risk of stricture * Profuse hemorrhage * Hospitalization (monitoring)
26
Why is a perineal urethrotomy less preferred in the canine?
* Difficult procedure (urethra deeper) * Increased risk of infection * Usually suture urethrotomy incision
27
Why is a perineal urethrostomy less preferred in canines?
* More tension * More cavernous tissue * More urine scald * More UTIs * Stenosis
28
What is a urethrostomy?
Surgical formation of a permanent opening of the urethra at a new site
29
Where is the preferred location for a urethrostomy in the canine? Why?
* Scrotal * More superficial * Relatively wide urethra * Less hemorrhage * Less urine scald (compared to perineal and pre-scrotal)
30
Where is the preferred location for a urethrostomy in the feline?
Perineal
31
What structures should be draped in the surgical field during a scrotal urethrostomy?
Abdomen, scrotum, prepuce
32
How long should the urethral incision for a scrotal urethrostomy be?
Midline incision in urethra should be 2.5-4cm long (5-8x urethral diameter)
33
What is the most appropriate suturing method for a scrotal urethrostomy?
* 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
What are the possible complications of a scrotal urethrostomy?
* Hemorrhage * Dehiscence * Urine scald * Stricture * UTI
35
What is a disadvantage of canine prescrotal urethrostomy?
Higher incidence of urine scald
36
When is a perineal urethrostomy in a cat indicated?
* Frequent obstructions * Strictures * Trauma
37
What are the goals of a perineal urethrostomy in cats?
* Adequate mobilization of urethra * Preserve urethral branches of the internal pudendal nerve with minimal dorsal dissection * Creation of a wide urethral orifice
38
What gland/area of the urethra do you dissect to when performing a perineal urethrostomy in a cat?
* 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
How can you check that the urethral orifice is wide enough during a perineal urethrostomy in a cat?
Ensure adequate width with mosquito hemostat to hinge
40
What are the complicatios of perineal urethrostomy in felines?
* Hemorrhage * UTI * Stricture * Subcutaneous urine leakage * Perineal hernia * Urinary incontinence * Urethrorectal fistula
41
How can you minimize stricture formation following perineal urethrostomy in a cat?
* Proper surgical technique * May be revised with second procedure * May require antepubic urethrostomy
42
What can cause subcutaneous urine leakage following a perineal urethrostomy in a cat? How can you treat it?
* Improper suturing * Urethral tear * Treat with indwelling 8 French catheter for 5-7 days
43
What is an antepubic urethrostomy and when is it indicated?
* 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
What are the possible complications of an antepubic urethrostomy?
* Urine scalding * UTI * Incontinence
45
What are the causes of urethral strictures?
* Usually caused by trauma * Urethral sx * Uroliths * Iatrogenic from catheterization * Healing after minor trauma
46
When do patients show clinical signs of urethral strictures?
\>60% narrowing
47
How do you diagnose urethral strictures?
* Urethrogram * Cystoscopy
48
How are urethral strictures treated?
* Treat if showing clinical signs * Urethral dilators * Balloon dilation * Resection and anastomosis * Proximal urethrostomy

Small animal surgery I (25 decks)

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