Urethra Flashcards
What is hypospadias?
- development of the terminal urethral orifice in an abnormal location
- usually in a more proximal location
- incomplete formation of penile urethra
How is hypospadias managed?
- if not causing urine scald, no treatment needed
- if problems, reconstruct urethral orifice and remove any tissue
What are the predisposing factors/causes of urethral prolapse?
- young, male brachycephalics
- primary conditions of straining: sexual excitement, UTIs, respiratory disorders
What are the clinical signs associated with urethral prolapse?
- bleeding from prepuce
- mucosa protruding from urethral orifice
- licking
What are the treatment options for urethral prolapse?
- reduce the prolapse with urethral purse string
- reduce and place urethropexy suture
- resection and anastomosis for necrotic or ulcerated tissue
Where are urethral obstructions most common in dogs?
ischial arch or just caudal to os penis
Where are urethral obstructions most common in cats?
in terminal area of the urethral (distal 1/3)
How are urethral obstructions diagnosed?
- plain radiographs
- ultrasound
- contrast urethrography
What are the goals of urethral obstruction treatment?
- maintain renal function and correct azotemia
- correct electrolytes
- temporarily relieve obstruction
- treat UTI if present
- prevent reoccurrence
How can a urethral obstruction be temporarily relieved?
- catheter is the best
- hydropropulsion
- cystocentesis
When is a urethrotomy indicated?
when there is a calculi that cannot be hydropropulsed
Why perform a prescrotal urethrotomy in dogs?
- common area of obstruction
- less bleeding
- heals better, less complications
What methods can be used for closure of a prescrotal urethrotomy in a dog?
- primary closure using a fine suture (less hemorrhage)
- healing by second intention (less risk of stricture)
Why should a perineal urethrotomy be avoided if possible?
- much deeper tissue
- more cavernosus tissue (more bleeding)
- higher incidence of infection
What is a urethrostomy?
creation of a permanent opening of the urethra at a new site
What are the indications for a urethrostomy?
- permanent damage
- recurrent urethral obstruction
- obstruction that cannot be retropulsed or removed by urethrotomy
What is the preferred area in the canine to perform a urethrostomy and why?
- scrotal
- less bleeding and complications
- less urine scald
How should you drape the patient during a scrotal urethrostomy?
How long should the incision be?
- drape entire abdomen such that the prepuce, scrotum, and abdomen are exposed
- incision should extend to the distal aspect of ischial arch
What are the possible complications of scrotal urethrostomy?
- hemorrhage
- dehiscence
- urine scald
- stricture
- UTI
What is a disadvantage of prescrotal urethrostomy?
higher incidence of urine scald
When is a perineal urethrostomy indicated in cats?
- salvage procedure to treat LUTDS and calculi in male cats
- frequent obstructions
- strictures
- trauma
What are the goals of perineal urethrostomy in cats?
- adequate mobilization of urethral mucosa
- preserve internal pudendal nerve
- widen urethral orifice
How far should you dissect the urethra in a perineal urethrosotomy of a cat?
to the pelvic urethra and bulbourethral gland
What are the complications of a perineal urethrostomy in a cat?
- hemorrhage
- UTI
- stricture
- subcutaneous urine
- perineal hernia
- urinary incontinence
- urethrorectal fistula
When is an antepubic urethrostomy indicated?
- when there is not sufficient urethra
- recurrent pelvic urethral obstruction
- failed perineal urethrostomy
What are the clinical signs associated with urethral trauma?
- clinical signs associated with urine accumulation
- electrolyte acidosis, hyperK, azotemia
- hematuria, stranguria
- SC or abdominal fluid accumulation
How is urethral trauma diagnosed?
contrast media
How is urethral trauma treated?
- if minor, catheterize
- if severe, resection and anastomsis
What are the causes of urethral strictures?
- iatrogenic (catheterization)
- urethral surgery
- trauma by uroliths
- healing after trauma
When are clinical signs seen associated with urethral strictures?
when there is at least 60% narrowing of the urethra
How are urethral strictures diagnosed?
- urethrogram
- cystoscopy
- contrast media
How are urethral strictures treated?
- urethral dilators in females
- balloon dilators in males
- proximal urethrostomy
- urethral stents
