Management of peristomal tissue necrosis following prepubic urethrostomy in a cat

This report describes the successful management of peristomal tissue necrosis following prepubic urethrostomy in a cat. The novel technique of temporary urethral ligation was used in combination with temporary tube cystostomy and vacuum assisted closure to allow for wound management prior to performing wound closure by utilization of a flank fold skin flap then definitive prepubic urethrostomy. Eleven month follow-up indicated excellent outcome with the cat having returned to normal behaviour apart from having adapted its posture to urinate.     

Prostatic squamous metaplasia in a cat with interstitial cell neoplasia in a retained testis

An 11-year-old cat with a retained testis was presented with a chronic history of dysuria and bladder atony. Medical therapy failed to alleviate the clinical signs. Contrast radiography demonstrated a diffusely narrowed urethra. During a celiotomy and prepubic urethrostomy, a retained testis, stenosed urethra, and irregularly enlarged prostate were observed. Histopathologic diagnosis was retained testis with a well-differentiated interstitial cell tumor, a poorly differentiated interstitial cell tumor, and marked squamous metaplasia of the prostatic epithelium with suppurative prostatitis. Neoplastic interstitial cells were immunoreactive for Melan A, consistent with reports of Melan A expression in steroid hormone-producing tissue. This is the first report of prostatic squamous metaplasia associated with testicular neoplasia in a felid.     

Prepubic urethrostomy: A long-term study in 16 cats

OBJECTIVE: To investigate the indications for and long-term outcome of prepubic urethrostomy (PPU) in the cat. STUDY DESIGN: Retrospective survey. ANIMALS: Sixteen cats that had undergone PPU. METHODS: Data were recovered from the medical records of the cats. Follow-up information was obtained from the owners and referring veterinarians. RESULTS: Indications for PPU were: failed perineal urethrostomy for the management of idiopathic lower urinary tract disease (ILUTD) (8 cats) or urethral trauma (1 cat); unresolved pelvic urethral obstruction after recurrent ILUTD (5 cats); and stenosis of the pelvic urethra as a result of trauma (2 cats). A patent urethral stoma was created in all cases. Signs of lower urinary tract disease were present in 8 cats postoperatively. With appropriate dietary management, these signs resolved in 2 cats and improved in another 4 cats. Eleven cats experienced postoperative complications that consisted of peristomal skin irritation or necrosis (7 cats) and urinary incontinence (6 cats). Complications developed in the immediate postoperative period in 6 cats, and resolved in 2 of these. Six cats developed late complications, at 6 to 84 months postoperatively. Six cats were euthanatized between 1 and 26 months' postoperatively. The mean survival time in these cats was 13 months. Reasons for euthanasia included urinary incontinence (3 cats), skin necrosis (2 cats), and unresolvable ILUTD (1 cat). CONCLUSIONS: PPU is a salvage procedure that is successful in relieving the signs of urinary tract obstruction and preventing further obstruction. However, potential complications should limit its use to cases in which standard techniques for perineal urethrostomy cannot be performed. CLINICAL RELEVANCE: PPU is a comparatively simple procedure that should be considered as a salvage technique for obstructive disease of the pelvic urethra.     

Surgical procedure and postoperative management of a perineal urethrostomy in a chimpanzee (Pan troglodytes).

A chimpanzee (Pan troglodytes) with traumatic loss of the distal penis developed a gradually enlarging ventral urethral swelling and progressive dysuria. Endoscopy identified a urethral diverticulum, and endoscopic resection of the diverticulum wall was performed. Postoperative infection caused extensive necrosis of the penis, which necessitated a perineal urethrostomy. Complications of the urethrostomy included urethral obstruction from recurrent urethral stricture. The stricture was managed by regular dilatation using urethral bougies. Because of considerable postoperative swelling, catheterization was required to allow micturition following both the diverticular resection and polyp debulking. A shortened catheter sutured to the skin was tolerated for up to 10 days. Four yr after the urethrostomy, the animal is healthy and asymptomatic with endoscopic examinations performed at 12 mo intervals. This case demonstrates that with appropriate aftercare, perineal urethrostomy is an effective technique in the treatment of chronic distal urethral obstruction in the chimpanzee and probably other primate species.     

Transpelvic urethrostomy in 11 cats using an ischial ostectomy

OBJECTIVE: To investigate the feasibility and long-term outcome of a modified subpubic urethrostomy technique termed transpelvic urethrostomy (TPU) in cats. STUDY DESIGN: Prospective clinical study. ANIMALS: Eleven male cats with obstructive lower urinary tract disease that could not be relieved, and requiring a surgical urinary diversion, were selected for TPU. METHODS: With the cat in dorsal recumbency, the penis was exposed and the ventral pelvis was denuded by median adductor muscle elevation. An approximately 12 mm x 15 mm area of ischium was removed. The pelvic urethra, 8-20 mm cranial to the bulbourethral glands, was incised longitudinally and sutured to the skin to create a urethrostomy. RESULTS: All cats were neutered males (2-9 years); none were uremic or hyperkalemic at admission. Urine was cultured if there was leukocyturia, nitrituria, and/or bacteriua. Bacteria were isolated from 2 specimens. A patent urethrostomy was created in all cats without operative complications. Except for 1 cat without associated clinical signs, stricture was not evident between 9 and 42 months after urethrostomy. One cat had postoperative urinary incontinence (UI) that resolved within 4 weeks. Two cats each had 1 episode of idiopathic lower urinary tract disease after 6-month follow-up; both responded to medical therapy. CONCLUSIONS: TPU was used as a successful urinary diversion procedure relieving signs of urinary tract obstruction and preventing further obstruction, with few complications. The incidence of UI after TPU remains minimal. CLINICAL RELEVANCE: TPU should be considered as a salvage urinary diversion procedure in cats (as an alternative to prepubic and subpubic techniques). TPU may also be considered as a possible primary urinary diversion solution (an alternative to perineal urethrostomy) for obstructive lower urinary tract disease in cats.     

Perineal urethrostomy in a brown capuchin monkey (Cebus apella).

A 14-yr-old male brown capuchin monkey (Cebus apella) was presented to the Veterinary Teaching Hospital of the Hebrew University of Jerusalem, Israel, with stranguria. The history included distal urethral obstruction and a previous surgical attempt to create a urinary diversion through the perineum. A perineal urethrostomy was performed. In a 17-mo follow-up period, neither stranguria nor dysuria was observed, and the monkey's social behavior appeared normal. Perineal urethrostomy appears to be a simple and practical procedure in primates with a compromised distal urethra.     

Priapism after castration in a cat

Priapism developed in a cat 2 days after castration and strangury. The priapism was unresponsive to massage and antimicrobial treatment. Because of penile engorgement and necrosis, a perineal urethrostomy was performed. Clinical signs of priapism resolved after urethrostomy. Histologic examination of tissues revealed vascular stasis within the corpus cavernosum penis and funiculitis of the right spermatic cord.     

Management of incontinence following pre-pubic urethrostomy in a cat using an artificial urethral sphincter

A 14-year-old male neutered domestic shorthair cat presented with a 4-year history of urinary incontinence following prepubic urethrostomy. Physical examination confirmed peristomal dermatitis, urine scalding and constant urine leakage. Haematology, serum biochemistry and urinalysis were unremarkable. Ultrasonography revealed a non-distended urinary bladder. An artificial urethral sphincter mechanism, with subsequent incremental inflation of the cuff 6 weeks later, resulted in complete resolution of clinical signs, return to normal urinary function and excellent quality of life. The cat was still continent at 5-year follow-up. Further studies including additional cases are required to highlight effectiveness and harms of the procedure.     

A simple continuous pattern using absorbable suture for perineal urethrostomy in the cat: 18 cases (2000-2002)

Closure with a simple continuous pattern using absorbable suture was evaluated in 18 cats that underwent perineal urethrostomy from 2000 to 2002. The perineal urethrostomy was performed in a similar manner in all the cats, and either 4-0 or 5-0 polydioxanone was used for closure. Cats were evaluated 2 weeks postoperatively, and long-term follow-up information was reviewed. In all cats, the perineal urethrostomy site was healed within 2 weeks. None of the cats developed a stricture postoperatively. Complications were not significantly different (P>0.50) from those found in a comparison group of 21 cats operated between 1997 and 2002, in which perineal urethrostomies were performed using nonabsorbable sutures that were removed postoperatively.     

A technique for perineal urethrostomy in the cat

A technique for perineal urethrostomy in the cat is described and the results of its successful use in fifteen consecutive cases reported. The pelvic urethra is sutured to skin to produce first intention healing.     

Prepubic urethrostomy and placement of a caudal superficial epigastric flap for treatment of a self-mutilation injury in a serval

A 10-year-old male serval was examined for treatment of a self-inflicted perineal wound that obliterated the ventral anocutaneous junction, penis, scrotum, testicles, and proximal portions of the caudomedial thigh muscles. Repair required placement of a caudal superficial epigastric flap and prepubic urethrostomy. Although it is generally preferable to delay repair of contaminated wounds until a healthy wound bed is established, circumstances related to wound location, affected tissues, and patient compliance led to a decision for immediate wound closure. In this serval, a history of food intolerance, recent diet change, eosinophilia, and eosinophilic granuloma-like skin lesions suggested that the self-mutilation injury was a result of food hypersensitivity, although foreign body or a spider bite could not be ruled out.     

Presumptive pseudohypoaldosteronism secondary to chronic urinary tract obstruction from sloughed urinary bladder mucosa and urinary tract infection in a cat

Objective – To describe a case of presumptive secondary pseudohypoaldosteronism (PHA) in a cat with urinary tract infection and chronic urethral obstruction. The obstruction was believed to have resulted from sloughed urinary bladder mucosa secondary to pressure necrosis. Case Summary – A 5‐year‐old, 4 kg, castrated male Siamese cat presented for vomiting and stranguria. Medical history included a perineal urethrostomy for urethral obstruction. Physical examination revealed a large, painful, nonexpressible urinary bladder. Point‐of‐care testing demonstrated electrolyte derangements consistent with a postrenal azotemia and metabolic acidosis. Results of urine culture was positive for bacterial growth. Diagnostic imaging revealed presence of retroperitoneal fluid, marked urinary bladder wall thickening, bilateral hydroureter, mild bilateral pyelectasia, and small nephroliths. The patient was treated for a urinary tract obstruction and infection. In the 3 weeks following initial discharge, the patient was evaluated on multiple occasions for lethargy, intermittent vomiting, inappropriate urination, and progressive polyuria and polydipsia. Although the urinary bladder was easily expressed during repeat examinations, it was persistently distended and subjectively thickened upon palpation. Repeat ultrasound of the urinary tract showed evidence of sloughed tissue in the bladder lumen, likely secondary to chronic urethral obstruction and pressure necrosis. A cystotomy was performed to remove the necrotic tissue, and a revised perineal urethrostomy was done due to a partial urethral stricture. Bladder biopsies were obtained at this time. Postoperatively, the cat was reported by the owners to be urinating normally but continued to be polyuric and polydipsic in the week following discharge. One week after surgery, the cat presented in hypovolemic shock with laboratory findings consistent with a presumptive diagnosis of secondary PHA. New or Unique Information Provided – PHA has not been reported previously in a cat. This case report suggests that aldosterone resistance should be considered in cats with consistent laboratory findings and a history of documented obstructive uropathy and urinary tract infection.     

Delayed urethral obstruction after uterine torsion in a pregnant dog

A 4 yr old pregnant female shih tzu was presented with abdominal discomfort and bloody vulvar discharge. The nongravid uterine horn was reflected caudally over the trigone, obstructing urine outflow. A cesarian section and ovariohysterectomy were performed. Postoperatively, the hematuria and pollakiuria resolved. Seventeen days later, the pelvic urethra was completely obstructed by a soft tissue mass that was identified by rectal palpation, blocked catheterization attempts, contrast radiography, ultrasonography, and surgery. Management included temporary cystostomy tube and definitive prepubic urethrostomy. Histologic diagnosis was severe, multifocal, necrosuppurative urethritis with fibroplasia, fibrosis, and cellulitis, apparently secondary to ischemia. Delayed urethral obstruction is a potential complication of canine uterine torsion.     

Traumatic urethral avulsion at the preputial fornix in a cat

A cat with pelvic fractures from being hit by a car had voided no urine in 13 hours despite iv administration of fluids. Abdominal radiography had revealed the pelvic fractures and apparently intact urinary bladder. Urine did not flow from a urethral catheter, and contrast radiography revealed the catheter to be extra-urethral within the penis. Intravenous pyelography revealed intact ureters and urinary bladder; celiotomy confirmed intact urinary bladder. Cystotomy and normograde urethral catheterization allowed localization of the ruptured urethra within the deep subcutaneous tissues of the caudal portion of the abdomen. After closure of the cystotomy and celiotomy incisions, perineal urethrostomy was performed.     

Antibiotic-resistant Corynebacterium jeikeium urinary tract infection in a cat

A 10-year-old, castrated male, domestic longhaired cat with a history of urinary tract disease and perineal urethrostomy was presented for evaluation of persistent urinary tract inflammation. Prior to referral, diphtheroid organisms had been cultured from a urine sample obtained by cystocentesis, and they were interpreted as sample contamination. Subsequent urine culture and gene sequencing identified Corynebacterium jeikeium, which was resistant to antibiotics and appeared to be the cause of the urinary tract infection.     

The use of a low-profile cystostomy tube to relieve urethral obstruction in a dog

A 10-year-old, spayed female Dalmatian was diagnosed with granulomatous urethritis causing urethral obstruction. Due to the extensive involvement of the urethra, a urethrostomy was not possible. A commercially available, silicone, low-profile gastrostomy tube was placed as a prepubic cystostomy tube to achieve urinary diversion. This tube is easy to use, has a one-way valve, and lies flush with the skin margin, thereby decreasing the likelihood of inadvertent removal. This tube should be considered to achieve long-term urinary diversion when urethral involvement is extensive.     

Clinical management of the feline urological syndrome

The management of cases of the feline urological syndrome (FUS) is described with particular reference to urethral obstruction in the male cat. Treatment of the obstructive episode and in the post–obstruction period and the prevention of recurrence of blockage in the longer term are discussed and a technique for perineal urethrostomy described.     

Endoscopic lithotripsy of a urinary bladder calculus with the aid of a holmium-YAG-laser in a gelding

A 6 year old Haflinger gelding was presented to the reporting clinics with a history of chronic dysuria. A large cystic calculus (12 x 9 x 9 cm) was diagnosed cystoscopically. Lithotripsy was carried out endoscopically in the standing, sedated patient with a Holmium:YAG surgical laser (2100 nm, 0.5-3.5 J/pulse, 3-60 pulses/sec.). The endoscope was inserted into the bladder via perineal urethrostomy. Fragmentation of the urolith was carried out with a laser fiber (core diameter 600 microns) in contact mode. Healing proceeded uneventfully. On follow up examination 8 weeks post surgery, no signs of recurrence, cystitis or strictures of the urethra were present.