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.     

Surgical revision of the urethral stoma following perineal urethrostomy in 11 cats: (1998-2004)

Eleven cats required urethral stoma revision because of urethral stricture following perineal urethrostomy. At surgery, eight cats had evidence of inadequate dissection to the bulbourethral glands, and three cats had evidence of urine extravasation into the subcutaneous tissues. Following revision of the stoma, long-term follow-up was obtained in nine cases. For eight cats, owners reported no complications after the revision. Failure to dissect beyond the bulbourethral glands and inadequate mucosa-to-skin apposition resulted in postoperative stricture formation. Stoma revisions were performed a median of 71 days following the initial perineal urethrostomy, indicating that long-term evaluation of cases is necessary.     

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.     

Retrospective study of indications for and outcome of perineal urethrostomy in cats

OBJECTIVES: To evaluate indications for and outcome of perineal urethrostomy in cats. METHODS: The medical records of 59 cats that had undergone perineal urethrostomy were evaluated. Short-term follow up information (for a period of four weeks following surgery) was available for all of the cats. Long-term follow up information (for a period of at least four months) was available for 39 cats. RESULTS: Early complications occurred in 25.4 per cent of cats and late complications were observed in 28.2 per cent of cats. The most frequent late complication was recurring bacterial urinary tract Infection. CLINICAL SIGNIFICANCE: Despite frequent complications and recurring signs of lower urinary tract disease, 32.2 per cent of the cats had a disease-free long-term outcome (mean four years, median 3.9 years), and 88.6 per cent of clients interviewed thought that their cats had a good quality of life after surgery.     

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.     

Preservation of striated-muscle urethral sphincter function with use of a surgical technique for perineal urethrostomy in cats

It has been reported that perineal urethrostomy resulted in impairment of striated-muscle urethral sphincter function in male cats, as measured by urethral pressure profilometry and electromyography (EMG). Our study was undertaken to describe and evaluate a surgical technique for perineal urethrostomy that reduces trauma to the urethral branches of the pudendal nerve. Perineal urethrostomy was performed on 10 healthy neutered cats after demonstrating that they had normal urethral sphincter function by urethral pressure profilometry (maximal urethral closure pressure [MUCP] = 151 +/- 52 cm of water) and EMG activity at the level of the striated-muscle sphincter before surgery. All cats had normal urethral sphincter function 1 week (MUCP = 194 +/- 19 cm of water, EMG activity present) and 3 weeks (MUCP greater than 200 cm of water, EMG activity present) after surgery. These results indicated that preservation of the urethral branches of the pudendal nerve during urethrostomy preserved striated-muscle urethral sphincter function.     

Feline Perineal Urethrostomy: A Review of Past and Present Literature

Urethral obstruction is a potentially fatal condition and in cases of recurrent obstruction or an identified cause that is refractory to medical management, a urethrostomy may be performed for definitive treatment. Perineal urethrostomy is the surgical creation of a permanent stoma in the wider pelvic urethra via anastomosis to the perineal skin. Diagnosis of the underlying cause of obstruction, proper perioperative treatment, and an understanding of the anatomy and surgical technique, are imperative to the success of this procedure. This review intends to highlight these aspects, as well as the common complications and expected prognosis to aid decision making in the management of these cases.     

Evaluation of concurrent perineal hernia in adult male dogs presenting with nontraumatic,acquired inguinal hernias

A possible association between the development of nontraumatic, acquired inguinal hernias (NAIH) and perineal hernias (PH) has been postulated in adult dogs. The objective of this study was to evaluate the frequency of concurrent diagnosis of PH in dogs presented with NAIH and determine potential risk factors for concurrent PH and NAIH. Medical records of adult male dogs presented for NAIH to 4 hospitals between 2007 and 2017 were retrospectively reviewed. Twenty-one dogs with NAIH were included, 8 of which had concurrent PH. There were no significant differences between dogs with and without PH; however, among dogs with both conditions, intact dogs (8.1 ± 1.4 years) were younger than neutered dogs (11.7 ± 1.0 years; P = 0.007). Thirty-eight percent of male dogs presenting for NAIH had concurrent PH, indicating that these conditions commonly occur together. Dogs presenting for NAIH should be carefully evaluated for concurrent PH before surgical intervention.     

Buccal mucosal graft urethroplasty for reversal of a perineal urethrostomy in a goat wether

OBJECTIVE: To describe the use of buccal mucosa as a urethral graft for reversal of perineal urethrostomy (PU) in a castrated male goat. STUDY DESIGN: Clinical case report. SAMPLE POPULATION: One client-owned castrated male goat. RESULTS: An 8-month-old Pygmy cross wether was admitted for urolithiasis and PU stricture. After repeated unsuccessful attempts at urethrostomy reversal and urethral reconstruction, a buccal mucosal graft was used for urethroplasty. Buccal mucosa proved to be an excellent graft for urethral repair. Normal urination has occurred through the reconstructed region for at least 24 months. CONCLUSIONS: Buccal mucosa worked well as a graft for urethroplasty and PU reversal. CLINICAL RELEVANCE: Grafting with buccal mucosa may also prove useful in other urethral repair techniques in small ruminants.     

Hypospadias in a polar bear (Ursus maritimus).

Corrective surgery on a 1.5-yr-old male polar bear (Ursus maritimus) with hypospadias included amputation of the vestigial penis, bilateral orchiectomy with scrotal ablation, and distal perineal urethrostomy. Hypospadias in other species is a congenital deformity that may be caused by extra- and intrauterine factors resulting in a disruption of the testosterone balance during urethral development, but the causative mechanism in this bear is unknown. The urethrostomy site was functional without complications 8 mo after surgery.     

Prevalence of bacterial urinary tract infection after perineal urethrostomy in cats.

It has been reported that the prevalence of bacterial urinary tract infection (UTI) increases after perineal urethrostomy in male cats. Perineal urethrostomy, using a surgical technique preserving striated urethral sphincter function, was performed on 2 groups of cats. The first group consisted of healthy castrated cats. The second group of cats had recurrent or persistent urethral obstruction. All cats had normal urethral sphincter function after surgery, as measured by urethral pressure profilometry and electromyography. Long-term periodic urinalysis and bacterial culturing of urine was performed on all cats. Twenty-two percent of the previously obstructed cats had recurrent bacterial UTI, compared with none of the healthy cats. On the basis of these findings, we suggest that perineal urethrostomy per se does not predispose cats to bacterial UTI, but surgical alteration of the urethral meatus combined with an underlying uropathy may increase the prevalence of ascending bacterial UTI after surgery.     

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.     

Evaluation of minimally invasive surgical reduction of sacroiliac luxation in toy breed dogs: a cadaver study

BackgroundMinimally invasive surgery (MIS) technique of sacroiliac luxation in toy breed dogs using cannulated screws has not been described.ObjectivesThe purpose of this study was to evaluate the effectiveness of pelvic canal recovery, the reproducibility of successful surgery outcomes, and the acceptable difficulty of the procedure in MIS of sacroiliac luxation in toy breed dogs.MethodsMIS using 2.3-mm cannulated screws was demonstrated in 12 toy breed dog cadavers with sacroiliac luxation artificially induced. Pre and postoperative radiographs were used to evaluate the pelvic canal diameter ratio (PCDR), hemipelvic canal width ratio (HCWR), and reduction rate. Dorsoventral angle (DVA) and craniocaudal angle (CCA) of the inserted screw were obtained postoperative computed tomographic scan.ResultsThe statistically significant difference between the mean pre and postoperative PCDR was found (1.10 ± 0.12 and 1.26 ± 0.11, respectively; p = 0.002), and the mean HCWR close to 1.0 meaning symmetric pelvis also was obtained (0.97 ± 0.07). The mean DVA and CCA were 2.26° ± 1.33° and 2.60° ± 1.86°, respectively.ConclusionsMIS of sacroiliac luxation using 2.3-mm cannulated screws is applicable to toy breed dogs with acceptable difficulty.     

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.     

Secretory patterns of growth hormone in dogs: circannual, circadian, and ultradian rhythms

The objective was to characterize the circannual, circadian, and ultradian secretory patterns of growth hormone (GH) in intact crossbred and purebred dogs. In all experiments, blood samples were collected with minimal stress by direct peripheral venipuncture and GH was measured in plasma by a homologous radioimmunoassay. For circannual studies, samples were collected monthly from 6 male dogs between 15:00 and 17:30 h over a 1-year time span. For circadian studies, blood samples were collected at 145-minute intervals from 09:00 to 06:45 h of the following day in 14 female dogs. In ultradian experiments, blood samples were collected at 15-minute intervals for 2.5 h (15:00 to 17:30 h) in 7 males and 7 females. Plasma GH in male dogs remained without change in summer, autumn, and winter but declined (P ≤ 0.01) in spring (LSM ± SEM; 6.9 ± 0.5; 6.0 ± 0.5; 6.3 ± 0.5; 4.3 ± 0.5 ng/mL, respectively). No plasma GH circadian rhythmicity was detected. Nor was any ultradian pattern evident in either males or females. No gender-related differences were observed in ultradian GH plasma profiles. It is concluded that, while basal GH levels show seasonal fluctuations in dogs, neither circadian nor ultradian GH secretory fluctuations were present in the dogs assessed.     

Use of polypropylene mesh in addition to internal obturator transposition: a review of 59 cases (2000-2004)

Fifty-nine dogs with a total of 69 perineal hernias that were repaired by internal obturator transposition and polypropylene mesh reinforcement were reviewed. Thirty-six dogs were available for follow-up at a mean of 29.4 months postoperatively. Six dogs had complications within the first 60 days of surgery, such as perineal swelling, persistent tenesmus, and incisional infections. Twenty-two dogs had excellent outcomes; seven dogs needed continued medical treatment after surgery; and seven dogs had poor outcomes. Hernias recurred in five dogs. The incisional infection rate was 5.6%; the recurrence rate was 12.5%; and the overall success rate was 80.5% for the 36 dogs with long-term follow-up.     

Cystoscopic examination of male and female dogs

The use of cystoscopy is advocated as an aid to the early differential diagnosis of disease of the canine bladder. Techniques are described for carrying out urethroscopy and cystoscopy in both male and female dogs using modern medical diagnostic instruments. Males were examined with flexible paediatric bronchofibrescopes, which permitted urethroscopy and cystoscopy, but to obtain extensive biopsies or undertake cauterisation of the bladder surface with rigid endoscopes, a simple perineal urethrostomy was necessary. The bladder of females, on the other hand, was examined by cystoscopy and biopsied using standard rigid cystoscopes and resectoscopes.     

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.     

Bilateral ventriculocordectomy via ventral laryngotomy for idiopathic laryngeal paralysis in 88 dogs

Bilateral ventriculocordectomy through a ventral median laryngotomy was performed for the treatment of idiopathic laryngeal paralysis in 88 dogs. The purpose of this retrospective analysis was to provide long-term follow-up for a large number of dogs surgically managed with this technique. A combination of medical record and completed client questionnaire information provided short-term (14 days) follow-up for 88 dogs and long-term (>6 mo) follow-up for 42 dogs. Major short-term postoperative complications were identified in 3 of 88 (3.4%) patients. Major long-term complications were identified in 3 of 42 (7.1%) patients. The results of surgery were considered to be very satisfactory in 93% and unsatisfactory in 7%. Three dogs in this series developed aspiration pneumonia. Bilateral ventriculocordectomy through a ventral median laryngotomy is associated with a low incidence of both short- and long-term complications. Due to the ease of this procedure, the minimal surgical trauma to the patient, and the satisfactory results, this surgery should be considered an option for the treatment of idiopathic laryngeal paralysis in the dog.