Subtotal penile amputation and preputial urethrostomy in a dog

CASE DESCRIPTION: A 6-year-old castrated male Shih Tzu was evaluated because of intermittent bleeding during urination. CLINICAL FINDINGS: Necrosis of the cranial portion of the penile shaft extended distally from the preputial fornix. Penile necrosis secondary to strangulation from paraphimosis was diagnosed. TREATMENT AND OUTCOME: A midline preputiotomy incision was used to expose the penile shaft; amputation was performed caudal to the preputial fornix. The terminal portion of the urethra was anastomosed to the preputial mucosa, which allowed the dog to urinate through the preputial orifice. CLINICAL RELEVANCE: Unlike the more conventional urethrostomy procedures performed in dogs, preputial urethrostomy eliminates the potential for local skin irritation during urination. Preputial urethrostomy is also easier to perform in those dogs in which penile amputation is required adjacent to the preputial fornix. A release incision cranial to the prepuce can be used to facilitate caudal displacement of the preputial mucosa, which facilitates urethral anastomosis to this structure. A midline preputiotomy incision provided excellent exposure of the penile shaft for this surgical procedure.     

Bilateral epididymal sperm granulomas following urethrostomy in a German shepherd dog

Bilateral enlargement of both epididymes was observed in a 6-year-old German shepherd dog following a pre-scrotal urethrostomy. Testicular parenchyma showed regular structure, and the spermatogenesis and the steroidogenic functions were not modified. However, macroscopic examination of the tail and the body of both epididymes exhibited multiple white and well-delimited foci. Histopathological study of the epididymes confirmed the development of granulomas associated with extravasated spermatozoa. Urethrostomy caused a severe stenosis of the penile urethra, favouring the retention of urine at the urinary bladder. The retrograde pressure exerted by the distension of the urinary bladder could have allowed the urine to reach the prostatic urethra and the deferent ducts and, finally, the epididymes, causing irritation and rupture of the mucous layer of the epididymal duct, the consequent sperm extravasation and the development of sperm granulomas. We speculate that the inadequate surgical resolution of the urethral calculi caused the bladder distension, the subsequent retrograde flow of urine and the development of the lesions.     

Transpelvic urethrostomy in a Staffordshire bull terrier: a new technique in the dog

An eight-year-old male Staffordshire bull terrier was presented with a bleeding mass in the urethral mucosa 1.5 cm distal to the ischial arch. After cytological findings suggestive of a squamous cell carcinoma and confirmation of the mass with urethroscopy, total penile amputation followed by transpelvic urethrostomy using an ischial symphyseal ostectomy was performed. The procedure successfully produced a tension-free anastomosis of the urethra to the skin in the scrotal position and no major complications were observed in the postoperative period. Histologically, the lesion was reported as a ruptured vascular structure with thrombosis and repair tissue. Seven months after surgery the dog is free of clinical signs.     

Perineal urethrostomy.

Perineal urethrostomy can be used successfully in male cats to help manage certain lower urinary tract diseases. Indications and surgical technique are discussed and illustrated. Potential complications encountered with the surgical technique along with methods for preventing and managing are elaborated. With experience, perineal urethrostomy can be performed successfully and with minimal complications.     

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.     

Application of preputial tube-flap urethroplasty to establish a neourethra in a male dog with complications after preputial urethrostomy

A 14-year-old male poodle weighing 7.5 kg presented due to complications after preputial urethrostomy for management of preprostatic urethral rupture. Revision surgery was performed with preputial tube-flap urethroplasty via preputiotomy. A longitudinal flap was raised from the prepuce and anastomosed to the end of the previously cut urethra to create a neourethra and reduce tension at the urethrostomy site. Follow-up retrograde positive contrast urethrography performed 10 days and 6 months postoperatively showed no contrast leakage from either the neourethra tube flap or new preputial urethrostomy. A follow-up email questionnaire, based on the American Urological Association Symptom Index, was completed by the owner 6 months after surgery. The dog had excellent symptom scores, and urinated from the prepuce without difficulty in a manner resembling physiological urination.     

Penile amputation and scrotal urethrostomy in 18 dogs

The objective of this study was to report the signalment, indications for surgery, postoperative complications and outcome in dogs undergoing penile amputation and scrotal urethrostomy. Medical records of three surgical referral facilities were reviewed for dogs undergoing penile amputation and scrotal urethrostomy between January 2003 and July 2010. Data collected included signalment, presenting signs, indication for penile amputation, surgical technique, postoperative complications and long-term outcome. Eighteen dogs were included in the study. Indications for surgery were treatment of neoplasia (n=6), external or unknown penile trauma (n=4), penile trauma or necrosis associated with urethral obstruction with calculi (n=3), priapism (n=4) and balanoposthitis (n=1). All dogs suffered mild postoperative haemorrhage (posturination and/or spontaneous) from the urethrostomy stoma for up to 21 days (mean 5.5 days). Four dogs had minor complications recorded at suture removal (minor dehiscence (n=1), mild bruising and swelling around the urethrostomy site and mild haemorrhage at suture removal (n=2), and granulation at the edge of stoma (n=1)). One dog had a major complication (wound dehiscence and subsequent stricture of the stoma). Long-term outcome was excellent in all dogs with non-neoplastic disease. Local tumour recurrence and/or metastatic disease occurred within five to 12 months of surgery in two dogs undergoing penile amputation for the treatment of neoplasia. Both dogs were euthanased.     

Prepubic urethrostomy and vaginoplasty in a female cat

A 1-year-old, intact female, domestic shorthaired cat was presented for dysuria resulting from perineal scarring subsequent to injuries incurred during a cat fight. A prepubic urethrostomy was performed to manage the dysuria. Eleven months later, the cat was re-presented with a 3-day history of pyrexia and inappetence. A pinpoint opening extending 0.5 cm ventral to the anus on midline, exuding a clear discharge, was noted in the perineal region. A contrast fistulogram was performed, and a vaginoperineal fistula was diagnosed. The fistulous tract was a result of vulvar stricture from the trauma of the cat fight. A vaginoplasty was performed to create an opening for vaginal secretions. This is the first published report of a prepubic urethrostomy performed in a female cat.     

A description and evaluation of antepubic urethrostomy in the male cat

Urethral obstruction is common in male cats after the first year of life and is associated with a high mortality. It is often recurrent in spite of medical preventive measures, and in these cases antepubic urethrostomy may be performed. This technique utilizes the lengh of wide urethra which lies between the prostate gland and the bladder to divert urine through the ventral abdominal wall, thus bypassing the narrow penile urethra where obstruction occurs. The urethra is transected just cranial to the prostate gland and passed through a stab incision in the antepubic abdominal wall. The lateral ligaments of the bladder which include its nerve supply remain intact. Thirty-seven recurrent cases were operated on, and follow-up studies, averaging 8 months, were done on thirty-two of these. Twenty cats (62.5%) had a satisfactory post-operative course, but serious complications developed in the other twelve cases. Only two, however, developed obstruction in which urinary sediment could be implicated. Resumé. L'obstruction de l'urètre est fréquente chez le chat mâle âgé de plus d'un an, elle est entachée d'une forte mortalité. Malgré le traitement médical, elle présente souvent des rechutes et nécessite dans ces cas une uréthrostomie pré-pubienne. Cette technique met à profit la longueur de l'urètre large, se trouvant entre la glande prostatique et la vessie, ce qui permet de faire dévier l'urine à travers la paroi abdominale et de court-circuiter l'urètre pénien très étroit, siège de l'obstruction. L'urètre est sectionné juste devant la prostate et on le fait passer à travers une incision franche de la paroi abdominale pré-pubienne. Les ligaments latéraux de la vessie contenant les nerfs qui s'y rendent, restent intacts. On a ainsi opéré trente-sept cas de rechute, et trente-deux animaux ont été suivis pendant des périodes de 8 mois en moyenne. Vingt chats (62.5%) ont présenté une évolution post-opératoire satisfaisante, alors que les douze autres ont ue des complications sérieuses, mais dans deux cas seulement on a pu incriminer le sédiment urinaire. Zusammenfassung. Urethralverschluss ist bei Katern nach dem ersten Lebensjahr hâufig und mit hoher rtalitât Moverbunden. Trotz ârztlicher Vorbeugungsmassnahmen gibt es oft Rûckfâlle, und bei diesen kann die antepubische Urethrostomie durchgefûhrt werden. Bei dieser Methode wird die Strecke der weiten Harnrôhre, die zwischen Prostata und Blase liegt, dazu benutzt, den Urin durch die ventrale Bauchwand zu leiten und damit die enge Harnrôhre des Penis zu vermeiden, in welcher der Verschluss auftritt. Die Harnrôhre wird kurz vor der Prostata durchtrennt und durch eine Einstichôffnung in der antepubischen Bauchwand nach aussen gefûhrt. Die lateralen Ligamente der Blase, die ihre Nervenversorgung enthalten, bleiben intakt. 37 Rûckfalle wurden operativ behandelt, und 32 davon wurden anschliessend durchschnittlich 8 Monate beobachtet. Bei 20 Katern (62, 5%) war das Befinden nach der Operation gut, aber in den anderen 12 Fâllen traten ernstliche Komplikationen auf. Nur bei 2 Tieren kam es jedoch zur Obstruktion, fûr die Harnkonkremente verantwortlich zu machen waren.     

Vulvovaginectomy and perineal urethrostomy for neoplasms of the vulva and vagina

Vulvovaginectomy and perineal urethrostomy were performed in three dogs with extensive neoplasms of the vulva and vagina. One benign tumor (fibroleiomyoma) and two malignant tumors (transitional cell carcinoma and anaplastic spindle cell sarcoma) were diagnosed. Survival times were 9 weeks to 10 months. Urinary continence was preserved in all three dogs. The procedure may be curative for benign tumors or malignant tumors that have not yet metastasized; it is a palliative procedure for advanced malignancies.