Surgery of the urinary tract: Urethra and ureters

Question 1

Why is urethral disease common in males?

Answer 1

Due to the length and diameter of the urethra

Question 2

Describe the 3 parts of the urethral in males

Answer 2

Prostatic
• At neck of bladder
• Surrounded by prostate
Pelvic
• From prostate to ischial arch
• Can be injured due to pelvic fractures
Penile
• Ischial arch to orifice
• Prone to obstruction, does not distend

Question 3

Describe the urethra of females

Answer 3

• Shorter and wider than male dogs
• Urethral orifice on the ventral wall of vestibule, 0.5cm caudal to vaginovestibular junction
• Dorsal urethral wall in close association with ventral wall of vagina (urethra may be involved in genital disease)
• Urethral mucosa is folded allowing distention

Question 4

Describe some congenital abnormalities of the urethra

Answer 4

• Hypospadias: failure of fusion of the urogenital folds, incomplete formation of the urethra (abnormal urethral opening, more common in males)
• Epispadias: failure of fusion of the dorsal penile urethra
• Urethral fistulas

Question 5

Name some acquired disorders of the urethra

Answer 5

• Urethritis
• Urethral prolapse
• Urethral trauma
• Urethral stricture
• Urethral obstruction
• Neoplasia

Question 6

Urethritis is the result of?

Answer 6

Result of chronic inflammation: cystitis, prostatitis, vaginitis

Question 7

What factors predispose to urethritis?

Answer 7

UTI, urolithiasis, neoplasia, iatrogenic trauma

Question 8

What are the clinical signs of urethritis?

Answer 8

• Stranguria, pollakiuria, haematuria

- Urethral thickening may be palpable on digital rectal exam

Question 9

What can occur following urethritis?

Answer 9

• Stricture

- Urethral prolapse

Question 10

What are the clinical signs of urethral prolapse in male dogs?

Answer 10

• Licking of penis
• Bleeding
• Protrusion of urethral mucosa through external urethral orifice of penis

Question 11

How is urethral prolapse treated?

Answer 11

• Reduction of prolapsed segment if protrusion minimal and asymptomatic: catheterise urethra and place purse string in tunic of penis at external urethral orifice for 5 days
• Resection of prolapsed tissue: haematuria for few days postop
• Castration

Question 12

What is the most common urethral disease?

Answer 12

Urethral obstruction

Question 13

Urethral obstruction requires urgent management otherwise..?

Answer 13

• Uraemia and death

- Prolonged bladder distention > loss of detrusor muscle may be permanent

Question 14

Name some causes of urethral obstruction

Answer 14

• Urolithiasis
• Urethral plugs (mucus and crystals, male cats/FLUTD, distal 3rd of urethra)
• Neoplasia (bladder tumours invading urethra)
• Granuloma
• Bladder displacement/herniation
• Strictures
• Trauma
• Blood clots due to idiopathic renal haematuria
• Idiopathic

Question 15

What are some clinical signs of urethral obstruction?

Answer 15

• Variable; depending on degree and duration of obstruction
• Dysuria
• Anuria
• Haematuria
• Dripping urine (owners may report ‘incontinence’)
• Abdominal distention
• Pain
• Signs of uraemia (>2days)

Question 16

How is urethral obstruction diagnosed?

Answer 16

• History
• Abdominal palpation
• Inability to pass urinary catheter
• Abdominal Radiography
• Abdominal ultrasound

Question 17

How is urethral obstruction managed?

Answer 17

• Empty bladder: cystocentesis
• Fluid therapy
• Attempt urethral catheterization: under ga
• Once obstruction resolved pass advance u+ catheter in the bladder and empty it
• Cystostomy to remove calculi

Question 18

What is the indication for Urethrotomy

Answer 18

Removal of calculi that cannot be dislodges by urohydropropulsion

Question 19

What is the most common complication of Urethrotomy ?

Answer 19

Haemorrhage

Question 20

What is a urethrostomy and its uses/indications?

Answer 20

Creation of permanent opening into urethra
Indications:
- Recurrent or persistent obstruction due to uroliths
- Urethral stricture
- Severe penile trauma

Question 21

What are the indications for a feline perineal urethrostomy?

Answer 21

• Failure to resolve urethral obstruction
• Recurrent urethral obstruction
• Penile urethral stricture
• Severe urethral trauma

Question 22

What post-op care is needed following a feline perineal urethrostomy?

Answer 22

• Elizabethan collar until sutures removed
• Don’t use litter
• Do not place indwelling urinary catheter

Question 23

What are the causes of urethral trauma?

Answer 23

• Abdominal trauma
• Pelvic fracture
• Iatrogenic

Question 24

What are the clinical signs of urethral trauma?

Answer 24

• Haematuria, dysuria, anuria
• Pain
• Abdominal distention
• Signs of peritonitis
• Signs of uraemia

Question 25

How is urethral trauma diagnosed and treated?

Answer 25

• History
• Radiography (plain and retrograde urethrogram)
• Haematology and serum biochemistry
• Attempt urethral catheterization to establish urethral patency
• Stabilise patient with fluid therapy
• Minor trauma: conservative management: place urethral catheter for 5-10 days
• Surgical repair

Question 26

Which animals are mostly affected by urethral tumours?

Answer 26

Older female dogs

Question 27

Which urethral neoplasia are the most common?

Answer 27

TCC and SCC more common

Metastasis in >50% of cases