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.     

Modified perineal urethrostomy using preputial mucosa in cats

A modified perineal urethrostomy was performed in 14 males cats with partial or complete urethral obstruction. Follow-up information was available for 2 to 18 months. By use of this method, the preputial tissues were preserved, and the penile urethra was anastomosed to the preputial mucosa to enlarge and lengthen the urethra. Urine flow was reestablished in all cats without evidence of urethral stenosis or other major complications. Appearance of the perineal region and prepuce was not substantially altered.     

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.     

Use of a preputial circumferential mucosal flap for hypospadias management in a Boston terrier

An eight-week-old male Boston terrier presented for penile desiccation and urine pooling in the prepuce due to congenital hypospadias. An advancement flap was created from the dorsal mucosa of the incompletely formed prepuce and sutured circumferentially to construct a longer distal preputial mucosa. V- to Y-plasty of the ventral abdominal skin was utilised to create the preputial skin overlying the mucosal flap. Urethrostomy and partial penile amputation were also performed. Following surgery, the clinical signs of penile desiccation and preputial urine pooling resolved and acceptable cosmetic appearance was achieved. This technique may be considered for glandular or penile hypospadias or following resection of the ventral aspect of the distal prepuce when inadequate tissue is present for a simple two-layer closure of the preputial mucosa and skin.     

Laparoscopic-assisted enterostomy tube placement and full-thickness biopsy of the jejunum with serosal patching in dogs

OBJECTIVE: To develop laparoscopic-assisted techniques for enterostomy feeding tube placement and full-thickness biopsy of the jejunum in dogs. ANIMALS: 15 healthy dogs. PROCEDURE Dogs were anesthetized, and positive pressure ventilation was provided. A trocar cannula for the laparoscope was inserted on the ventral midline caudal to the umbilicus. For enterostomy tube placement, a second trocar cannula was placed lateral to the right rectus abdominis muscle, and a Babcock forceps was used to grasp the duodenum and elevate it to the incision made for the cannula. The duodenum was sutured to the abdominal wall, and a feeding tube was inserted. For jejunal biopsy, a third trocar cannula was placed lateral to the left rectus abdominis muscle. A portion of jejunum was elevated to the incision for the second or third cannula, and a full-thickness biopsy specimen was obtained. A second specimen was obtained from another portion of jejunum, and retention sutures for the 2 biopsy sites were tied so that serosal surfaces of the biopsy sites were apposed to each other. Dogs were euthanatized 30 days after surgery. RESULTS: The enterostomy tube was properly positioned and functional in all 8 dogs that underwent laparoscopic-assisted enterostomy tube placement, and sufficient samples for histologic examination were obtained from all 7 dogs that underwent laparoscopic-assisted jejunal biopsy. None of the dogs had any identifiable problems after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in dogs, laparoscopic-assisted procedures for enterostomy tube placement and jejunal biopsy are an acceptable alternative to procedures performed during a laparotomy.     

Preputial damage and lateral penile displacement during castration in a degu

CASE DESCRIPTION: A 2-month-old male degu was treated for preputial damage and lateral penile displacement that occurred during attempted castration. CLINICAL FINDINGS: Bruising and swelling of the prepuce and severe edema to the left of the prepuce were evident. The penis could not be extruded from the prepuce. Radiography revealed a large bladder. Contrast medium injected into the prepuce filled the peripreputial subcutaneous tissues. TREATMENT AND OUTCOME: During surgical exploration through a peripreputial approach, the penis was found to be completely separated from the prepuce and located in the adjacent subcutaneous tissue. The penis was repositioned in the prepuce and anchored with a suture at its base. The following day, the preputial orifice was crusted over, urine was leaking from the incision, and the penis could not be extruded from the prepuce. The anchoring suture was removed, and the tip of the penis was sutured to the preputial orifice so that the penis protruded slightly from the prepuce. Urination was normal after the second surgery. Two years later, the preputial orifice remained adhered to the distal portion of the penis and the exposed penile tissue was healthy. CLINICAL RELEVANCE: Penile displacement from the prepuce is an unusual complication of castration in degus. The surgical technique used in this animal may be an effective means of repair. Permanent exposure of the tip of the penis may be well-tolerated in degus.     

Squamous cell carcinoma of the equine external genitalia: a review and assessment of penile amputation and urethrostomy as a surgical treatment

A retrospective analysis was performed on 48 cases of suspected neoplasia involving the equine external genitalia. Forty nine squamous cell carcinomata (SCC) and 23 squamous papillomata (SP) were identified. Two cases of epithelial hyperplasia and one case of habronemiasis were also recognised histopathologically. The glans penis was the most common site of tumour development accounting for 53 per cent of cases of SCC and 61 per cent of SP. The urethral diverticulum, urethral process or urethra was involved in 27.6 per cent (8/29) of cases of SCC. Twelve per cent (5/41) of cases of SCC were confirmed to have metastatic involvement of the local lymph nodes. Papillomata showing pre-malignant changes were identified in five cases. Seventy five per cent (36/48) of the animals presented were ponies. All were geldings, mean age 16.5 years. Penile amputation and urethrostomy, preputial ablation and proximal urethrostomy or local excision were used in the surgical management of these animals; three cases were inoperable and destroyed at presentation. Oedema, haemorrhage and stenosis of the urethrostomy site were encountered as post operative complications. Sixty six per cent (6/9) of animals with SCC of the glans penis (without urethral involvement), which had a known history over the follow up period, treated by penile amputation and urethrostomy survived for longer than 18 months. Similarly, of those with urethral involvement only 28.6 per cent (2/7) survived for a similar follow-up period. SCC not uncommonly affects the external genitalia of aged pony geldings and frequently the glans penis. If the lesion is identified before local metastasis occurs, penile amputation and urethrostomy is indicated and the prognosis is favourable.     

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.     

Characteristics of cisternal cerebrospinal fluid associated with intracranial meningiomas in dogs: 56 cases (1985-2004)

OBJECTIVE: To determine CSF characteristics associated with intracranial meningiomas in dogs. DESIGN: Retrospective case series. ANIMALS: 56 dogs with intracranial meningiomas. PROCEDURES: Medical records of dogs with a histopathologic diagnosis of intracranial meningioma, in which CSF analysis had been performed, were reviewed. Information concerning total nucleated cell counts (TNCCs) and differential nucleated cell counts, RBC counts, and total protein concentration in CSF; seizure history and glucocorticoid administration; and location of meningiomas was recorded. RESULTS: TNCCs < 5 cells/microL were detected in 41 of 56 (73%) dogs; 5 of 56 (9%) dogs had TNCCs > 50 cells/microL. Analysis of CSF revealed predominantly neutrophilic pleocytosis in < 20% of dogs. There was a significant association between meningioma location (caudal portion of the cranial fossa or middle and rostral portion of the cranial fossae) and increased TNCCs (> or = 5 cells/microL). CONCLUSIONS AND CLINICAL RELEVANCE: Results were significantly different from those routinely reported in the veterinary literature. Neutrophilic pleocytosis, especially with TNCCs > 50 cells/microL, was not typical in CSF samples from dogs with intracranial meningiomas. Neutrophilic pleocytosis may not be detected in CSF samples from dogs with meningiomas located within the middle or rostral portion of the cranial fossae.     

Penile Amputation and Sheath Ablation in the Horse

OBJECTIVE: To report a surgical technique for penile amputation and sheath ablation in horses. Study Design-Retrospective study. Animals or Sample Population-Twenty-five adult geldings of various breeds with conditions requiring penile amputation and sheath ablation. METHODS: The medical records of horses that had penile amputation and sheath ablation were reviewed. Briefly, the technique involved en bloc resection of the skin and subcutaneous tissues of the inner and outer lamina of the prepuce and penile shaft. Resection of the penile shaft, proximal to diseased segments, and spatulation of the urethral mucosa was followed by fixation of the penis to the ventral abdomen and closure of the peripreputial skin over the ventral aspect of the penis and creation of a new mucocutaneous junction at the urethral orifice. RESULTS: Mild to moderate postoperative hemorrhage occurred in all horses. Partial dehiscence of the mucocutaneous junction occurred in 8 horses; all healed by second intention. Postoperative pain lasting 24 to 48 hours occurred in 7 horses; 1 required epidural analgesia for pain relief. Long-term follow-up was available for 8 horses; none had any long-term complications. CLINICAL RELEVANCE: Partial amputation of the penis with pexy to the ventral abdomen and revision of the peripreputial skin can be used as an alternative to en bloc resection and penile retroversion for lesions involving the free part of the penis and the prepuce. It requires smaller incisions and results in less alteration to the normal appearance of the external genitalia than retroversion techniques, while still allowing the surgeon to remove extensive portions of the penis and extirpate the regional lymph nodes.     

Idiopathic chronic penile protrusion in the dog: a report of six cases

Idiopathic chronic penile protrusion was diagnosed in six dogs during a seven year period. All cases were treated surgically by using cranial advancement of the prepuce. The surgical technique was successful in four dogs, while the remaining two developed recurrence. In one of the latter cases, partial penile amputation was performed to correct the recurrent protrusion. Five dogs were available for follow-up clinical examination and all were found to be normal.     

Pyometra in an Inguinal Hernia in a Bitch

Pyometra in an inguinal hernia was diagnosed in a 10‐year‐old intact cross‐bred bitch which had had dysorexia, depression and inguinal distension. The hernia contained caudal portions of the two uterine horns, uterine cervix and cranial part of the vagina. As the organs were enlarged and full of pus, manual attempt to push back the uterine horns and the vagina in the abdominal cavity through the inguinal canal was unsuccessful. Herniated uterine horns were ligated and cut in their median portion, so it became possible to remove the cervix and the caudal portion of the horns through the hernial orifice, and the ovaries and the cranial part of the horns through a peritoneal midline incision. This bitch was not intended for breeding purposes and, given the presence of a huge pyometra associated with an inguinal hernia, an ovario‐hysterectomy was recommended. Uterine herniation should be considered as a differential diagnosis of a caudal lateral inguinal mass. When pushing the uterus back in the abdominal cavity is impossible, a surgical procedure should be performed to detect ischemia–reperfusion injury and/or a septic risk.     

A modified surgical technique for penile amputation and preputial ablation in the horse

The aim of this study was to describe a modified surgical technique for treatment of severe penile pathology, and the long‐term outcome. The surgery consisted of subischial urethrostomy and penile amputation with preputial ablation, with the horse in dorsal recumbency. A redundant section of the penis root and body was left in situ, rather than being retroflexed as described elsewhere. Follow‐up was obtained using a structured owner telephone questionnaire. The 15 cases included: 11 squamous cell carcinomas (73.3%); 2 melanomas; one chronic preputial discharge with no associated neoplasia; and one paraphimosis following routine sedation. Length of survival ranged from 0.9 to 74.6 months (median 25.1 months). From the 14 horses with follow‐up, 9 survived >18 months (64.3%) [Correction added on 17 August 2015, after first online publication: The percentage in the preceding sentence was wrong and has been corrected to '64.3%' from '69.2%']. Four euthanasias were due to presenting or post operative complications, while 2 were unrelated to the procedure. This procedure presents a simplified, viable option for treatment of extensive mixed penile lesions; reducing surgical complexity and time in comparison to previously described techniques requiring retroversion.     

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.     

Complicated urethral rupture and scrotal urethrostomy in a Bongo antelope (Tragelaphus eurycerus isaaci)

A 4-yr-old, 300-kg male Bongo antelope presented a fluctuant swelling on the ventral abdomen surrounding the penis, which was confirmed later as compatible with urethral rupture. Initial treatment included broad-spectrum antibiotic and radical surgical debridement. Total prepuce and partial penile amputation with orchidectomy was performed and normal micturition was restored. At a later stage, when the extent of the lesion was controlled, a permanent scrotal urethrostomy was performed. Complete healing by second intention was achieved 2 mo after the last surgery. Although the outcome was very good, considering the extent and severity of the tissue damage, prompt permanent urethrostomy when urethral rupture was first suspected would have prevented deterioration of the condition and prevented the need for extensive surgery.     

Bilateral pubic and ischial osteotomy for surgical management of caudal colonic and rectal masses in six dogs and a cat

CASE DESCRIPTION: 6 dogs and a cat were evaluated because of caudal colonic and rectal masses. CLINICAL FINDINGS: Tumors were identified in the caudal portion of the colon (n = 2), in the area of the colorectal junction (2), or in the rectum (3). TREATMENT AND OUTCOME: In all 7 animals, bilateral pubic and ischial osteotomy was performed to provide exposure of the rectum and associated tumor. Masses were successfully removed, and all 7 animals were able to ambulate normally within 3 days after surgery. No complications associated with the osteotomy procedure were identified. CLINICAL RELEVANCE: Findings suggested that bilateral pubic and ischial osteotomy provided sufficient exposure for resection of intrapelvic tumors in dogs and a cat with minimal complications.     

Reconstruction of the urethra by use of an inverse tubed bipedicled flap in a dog with hypospadias

CASE DESCRIPTION: A 1-year-old castrated male German Shepherd Dog was evaluated because of a history of hematuria and stranguria secondary to recurrent urinary tract infections. CLINICAL FINDINGS: Physical examination revealed hypospadias with penile and preputial aplasia. The urethral orifice was just ventral to the ventral aspect of the anocutaneous junction. Ascending urinary tract infections, secondary to fecal contamination of the urethral orifice, were the presumed source of recurrent bouts of cystitis that developed despite periodic antimicrobial treatment. TREATMENT AND OUTCOME: A 1-cm-diameter urethral extension was constructed from the urethral mucosal remnant located along the midline of the perineum (urethral trough). Two parallel 4-cm incisions (3 cm apart) were made lateral to that urethral trough. The borders were sutured to form an inverted, epithelium-lined tube (bipedicled flap) attached to the dorsal urethral orifice. The lateral skin margins were sutured over the reconstructed urethral extension, completing the procedure. Postoperative swelling necessitated temporary catheterization of the urinary bladder. After closure of a small fistula from the reconstructed urethral segment, the dog subsequently had only 2 episodes of cystitis during a 3-year period. To minimize skin irritation secondary to urine exposure, the dog's owner regularly trimmed the hair around the new urethral orifice. CLINICAL RELEVANCE: In dogs, correction of perineal (subanal) hypospadias via urethral reconstruction should be considered among treatment options. By use of an inverse tubed urethral extension, direct fecal contamination to the lower urinary tract may be effectively eliminated, dramatically reducing the incidence of ascending urinary tract infections in dogs with hypospadias.     

Suitability of the cranial portion of the vagina as a site for measurement of intra-abdominal pressure variations in dogs

OBJECTIVE: To determine whether the cranial portion of the vagina of dogs is a suitable site for measuring intra-abdominal pressure during cystometry. ANIMALS: 16 bitches (8 sexually intact and 8 spayed). PROCEDURE: 2 types of vaginal catheters were used to measure intra-abdominal pressure changes in anesthetized dogs. Catheters were inserted in the rectum and cranial portion of the vagina. RESULTS: Intra-abdominal pressure variations were detected with greater magnitude in the rectum than the cranial portion of the vagina, regardless of type of catheter used and reproductive status (sexually intact vs spayed) of the dogs. CONCLUSIONS AND CLINICAL RELEVANCE: The rectum was the better site for measuring intra-abdominal pressure changes in female dogs. Measurement of intra-abdominal pressure with concomitant measurement of intravesical pressure to determine detrusor pressure during cystometry in female dogs is more reliably detected from the rectum than the cranial portion of the vagina.     

Histomorphometric analysis of the proximal portion of the femur in healthy dogs

OBJECTIVE: To describe the cancellous bone architecture of the head and neck of the femur in healthy dogs by use of automated histomorphometry techniques in conjunction with histologic grading of articular cartilage. ANIMALS: 30 mature male dogs with healthy coxo-femoral joints PROCEDURE: Dogs were 1.5 to 4 years old and weighed 27 to 37 kg. Computer images of fine-detail radiographs of 100-microm-thick coronal and transverse plane sections of the head and neck of the femur (14 dogs) were analyzed by use of histomorphometry software. Statistical comparisons among histomorphometric indices of 4 regions were performed. Histologic preparations of coronal and transverse plane sections of femoral head articular cartilage (16 dogs) were graded. Median grades for lateral, medial, cranial, and caudal halves of the femoral head articular cartilage were determined. RESULTS: Bone volume/total volume, trabecular thickness and number, and bone surface/total volume were significantly higher in the femoral head than in the femoral neck. Anisotropy (trabecular alignment) and trabecular separation were significantly higher in the femoral neck than in the femoral head. Anisotropy was significantly higher in the caudal half of the femoral neck than in the cranial half. Cartilage had histologic grades indicating health without significant differences among lateral, medial, cranial, and caudal halves of femoral head cartilage. CONCLUSIONS AND CLINICAL RELEVANCE: A predictable cancellous architecture in the head and neck of the femur is associated with healthy cartilage.