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.     

Eversion of the Urinary Bladder: A Sequel to Third-Degree Perineal Laceration in the Mare

Two cases of urinary bladder eversion are described in association with third-degree perineal lacerations in the mare. One case of eversion followed surgical repair of the perineal defect. The other occurred spontaneously in a 5-month postpartum mare awaiting repair of a third-degree perineal laceration. Both everted bladders contained the pelvic flexure of the large colon, and in 1 case a bladder rent allowed evisceration. Surgical intervention was required, and was successful in one case.     

Perineal hernia in dogs--colopexy, vasopexy, cystopexy and castration as elective therapies in 32 dogs

In 32 male dogs colopexy, vasopexy, cystopexy and castration was performed for the treatment of perineal hernia. Recurrence rate in this study is 22%, what is comparable to other studies using different methods. The degree of severity and the number of complications is lower with this technique than with others. Enlargement of the prostate was evident in 59% and bladder retroflexion in 22% of the dogs. A celiotomy allows to recognize, assess, reduce and fix displaced organs which is not possible by using other methods. The aim is to regain the tubular structure of the ampulla recti and to fix prostate and bladder cranioventrally to the pelvic entrance. The castration performed at the same time causes the prostate gland to atrophy within 2-3 weeks, what makes the pelvic entrance even wider and the dogs return to normal defecation.     

Perineal hernia in 3 cats

Cases of perineal hernias in three cats are described. All the cats were male (2 castrated, 1 intact). The hernias were situated between the external anal sphincter and the levator ani muscle. The hernial sac contained a dilated rectum filled with fecal content (2 cats) as well as a small amount of retroperitoneal fatty tissue (2 cats) and urinary bladder (1 cat). A standard perineal herniorrhaphy in two cats, and herniorrhaphy via elevation of the internal obturator muscle in one cat were performed. No recurrence of the problem was observed in two cats during 9 months following the surgery. In one case, mild stretching of the pelvic diaphragm was noted with sporadic mild defecation problems observed after a 12-month period.     

Mineralized paraprostatic cyst as a potential contributing factor in the development of perineal hernias in a dog

Perineal hernias almost exclusively affect male dogs (sexually intact or castrated). Factors that may contribute or predispose a dog to perineal hernias include tenesmus, pelvic musculature variations (male vs female), and gonadal hormone influence. In dogs with perineal hernias and tenesmus it is important to include rectal and prostatic diseases, including paraprostatic cysts, in the differential list of potential underlying causes. Surgical correction of the perineal hernia with a perineal herniorrhaphy is indicated. Successful treatment depends on the degree of preexisting neurologic alterations, meticulous surgical technique, and identification and correction of underlying contributing factors. Paraprostatic cysts develop predominantly in sexually intact medium to large breed dogs. These cysts are thin-walled structures often attached to the prostatic dorsal midline. Osseous metaplasia of paraprostatic cysts may occur. Clinical signs of tenesmus often result from compression on adjacent structures (urinary bladder and colon), and tenesmus may contribute to the development of perineal hernias. Preferred treatment of a paraprostatic cyst is surgical removal and castration. This report describes a dog with bilateral perineal hernias and a large mineralized paraprostatic cyst that was identified as a possible contributing factor to the hernias.     

Bilateral ureterocystostomy in a 450-kg horse with ectopic ureters.

A 450-kg yearling Clydesdale filly was determined to have bilateral ectopic ureters. The resulting incontinence caused severe malodorous perineal dermatitis. Bladder capacity was measured at 800 ml. The urethral sphincter lacked tone, and the horse was seen to urinate in a normal manner only 2 or 3 times a week. A midline celiotomy was performed, and the ureters were identified by cannulation from the ectopic openings. The ureters were ligated, and the cut ends were anastomosed to the dorsal bladder surface by an extravesicular end-to-side technique. A partial thickness seromuscular layer of the bladder was sutured over the ureters in a cranial direction from the anastomosis site for 15 mm. This fixed the ureters to the dorsal surface of the bladder and protected the anastomosis site from tension. After surgery, the horse urinated n a normal manner many times a day. Urinary incontinence continued, but gradually improved. Bladder capacity increased over 13 months to 4.3 L. Surgical (urethral extension) and medical (phenylpropanolamine and estrogen) treatments were instigated to increase urethral sphincter tone. Urinary incontinence continued to improve and, at 11 months after surgery, incontinence was negligible, and the perineal dermatitis had healed.     

Observations on experimental perineal exteriorisation of the bovine urinary bladder.

A new technique for perineal exteriorisation of the urinary bladder was evolved and successfully performed in 15 buffalo calves (Bubalus bubalis). Its merits are maximum visibility of the bladder for cystorrhaphy and easy digital accessibility to the bladder neck. An indwelling urethral catheter made of polyvinyl chloride tubing with an improvised wire stilette was well tolerated for up to 20 days.     

Bladder outlet obstruction in a 6-month-old alpaca secondary to pelvic displacement of the urinary bladder

A 6-month-old female alpaca was presented for stranguria. Based on the history, physical examination findings, and radiographic studies, the alpaca was diagnosed with bladder outlet obstruction, secondary to pelvic displacement of the bladder, a condition previously unreported in camelids. Cystopexy was performed and the alpaca recovered unremarkably.     

Two occurrences of presumptive venous air embolism in a gelding during cystoscopy and perineal urethrotomy

A 14‐year‐old Arabian gelding presented for evaluation of macroscopic haematuria. Routine cystoscopy was performed under standing sedation during which the horse collapsed with apparent seizure activity. General anaesthesia was induced and the horse recovered neurologically normal. Four days later, during a perineal urethrotomy procedure, the horse experienced a similar collapse with seizure‐like activity. General anaesthesia was again induced and cystoscopy performed through the urethrotomy incision. A ventral bladder mass was visualised and sampled. Cytology confirmed a neoplastic process and the horse was subjected to euthanasia. Histopathology confirmed transitional cell carcinoma. Air embolism was the suspected cause of loss of consciousness and seizure activity in both instances.     

Treatment with a combined cystopexy-colopexy for dysuria and rectal prolapse after bilateral perineal herniorrhaphy in a dog

A 9-year-old castrated male Yorkshire Terrier was evaluated for dysuria and rectal prolapse 2 weeks after bilateral perineal herniorrhaphy. Dysuria was secondary to caudal displacement of the bladder, rather than retroflexion of the bladder. Dysuria and rectal prolapse were associated with disruption of supporting ligaments of the urinary bladder and colon, which may have been caused by tenesmus. Combined cystopexy and colopexy were used successfully to treat the dysuria and rectal prolapse.     

Perineal hernia with bladder retroflexion in a female cocker spaniel

Perineal herniation in the bitch is rare and its complication by bladder retroflexion in the bitch has not been previously reported in the literature. This case report describes a multigravid, five-year-old female cocker spaniel with bilateral perineal hernias, complicated by marked rectal sacculation and ventral bladder retroflexion. The case was managed initially by cystopexy and colopexy, followed seven days later by bilateral perineal herniorrhaphy. There was no recurrence of the problem by 12 months postsurgery.     

Use of laparotomy in a staged approach for resolution of bilateral or complicated perineal hernia in 41 dogs

OBJECTIVE: To evaluate the value of laparotomy as the initial step in the treatment of bilateral or complicated perineal hernia (PH) in dogs. STUDY DESIGN: Retrospective study. ANIMALS OR SAMPLE POPULATION: Forty-one dogs with PH. METHODS: Dogs with bilateral or complicated PH treated by a 2-step approach between November 1997 and December 2001 were studied. Inclusion criteria for complicated PH were: recurrence of PH, unilateral PH with a major rectal dilatation, PH with a concurrent surgical prostatic disease, and PH with retroflexed bladder. Colopexy, vas deferens pexy, cystopexy, and prostatic omentalization were performed during laparotomy as needed. Later, PH was performed by internal obturator muscle flap (IOMF) or if there was a perineal rent or weakness on the contralateral side, appositional herniorrhaphy was performed. Outcome was followed for >/=6 months. RESULTS: PH were bilateral (20 dogs) or unilateral (21). Twenty-one (51%) dogs had prostatic disease (clinical or ultrasonography diagnosis; 17 confirmed histologically) and 12 (29%) had urinary bladder retroflexion. Forty-one colopexies, 32 vas deferens pexies, 6 cystopexies, and 9 prostatic surgeries (omentalization or perineal cyst resection) were performed. PH was performed 2-20 days (median, 6 days) later: 61 IOMF transpositions, 13 appositional. Mean follow-up time was 26.6 months (range, 6-54 months, median, 27 months). PH was resolved in 37 (90%) dogs; 4 dogs had recurrence, and all occurred within 6 months. Thirty-eight (92%) dogs had an improved quality of life (good in 34 dogs, fair in 4 dogs). Wound complications occurred in 7 dogs (17%). Postoperative urine dribbling occurred in 15 dogs (37%) and was irreversible in 7 dogs (17%). Postoperative fecal straining persisted in 18 dogs (44%), and was permanent in 4 dogs (10%). Fecal incontinence did not occur. CONCLUSIONS: In bilateral or complicated PH, fixation of the urinary bladder and colon, and treatment of prostatic disease increase the chances of resolution. Emptying of the perineal space by organ pexy allows improved observation during herniorrhaphy. Despite a 90% clinical resolution, dogs with complicated PH treated by a 2-step protocol may have persistent urinary and fecal disorders. CLINICAL RELEVANCE: To improve the prognosis of bilateral or complicated PH, investigation and treatment of concomitant lesions (rectal, prostatic, bladder) should be part of a rational surgical strategy using a 2-step protocol.     

The use of porcine small intestinal submucosa as a biomaterial for perineal herniorrhaphy in the dog

OBJECTIVES: To develop an in vivo perineal hernia model, to develop a technique for using small intestinal submucosa (SIS) in perineal hernia repair, to further elucidate the biological behavior of SIS, and to compare SIS herniorrhaphy with the internal obturator muscle transposition (IOT) technique. STUDY DESIGN: Prospective evaluation comparing SIS herniorrhaphy with IOT. ANIMALS: Twelve adult castrated male, large-breed dogs. METHODS: All dogs had bilateral pelvic diaphragm defects created by complete excision of the levator ani muscle. Each dog had one side repaired using SIS and the other by IOT. Pain and inflammation were subjectively scored. Dogs were killed 2 weeks (n = 4), 12 weeks (n = 4), or 16 weeks (n = 4) after surgery. Each pelvic diaphragm was biomechanically tested to failure. The pelvic diaphragms from 2 normal dogs (n = 4 sides) were also biomechanically tested. Failure site, maximum pressure, displacement at failure, and initial linear stiffness values were determined. Histologic assessment was performed. Statistical analysis was performed with significance set at P <.05 RESULTS: No significant postoperative complications were noted. There were no significant differences in maximum pressure to failure, displacement, or stiffness when comparing normal, SIS, and IOT at any time point. The SIS group had significantly less displacement (P =.004) at 2 weeks than at weeks 12 or 16. For all herniorrhaphy techniques, the failure site was central (n = 22) or at the suture line (n = 2). At 2 weeks, histologic evaluation of tissues from the IOT group showed inflammation, mineralization, and necrosis, which were not present in tissues from the SIS group. Histologic examination at 12 and 16 weeks showed no microscopic differences in cell population or tissue characteristics between the IOT and SIS groups. CONCLUSIONS: SIS herniorrhaphy was successfully performed in this in vivo model of perineal hernia in the dog. CLINICAL RELEVANCE: This study suggests that SIS can be used as a primary means of repair, as augmentation when the internal obturator muscle is thin and friable, or as a salvage procedure in cases of recurrence in dogs with perineal hernia.     

TREATMENT OF UNILATERAL PERINEAL HERNIAS IN 2 MALE CHINCHILLAS (CHINCHILLA LANIGERA)

Two sexually intact adult male chinchillas were presented with a swelling in the perineal region. Radiographically both masses had a soft tissue opacity. Ultrasonography confirmed the tentative diagnosis of perineal hernia. In the first case the ultrasonographic examination revealed a fluid-filled structure inside the swelling, which was determined to be the urinary bladder. In the second case the hernia sac was filled with homogeneous tissue, belived to be fat. Subsequently, unilateral perineal herniorrhaphies including an internal obturator muscle flap transposition technique were performed. Both chinchillas recovered well with subsequent uneventful healing of the surgical sites. No long-term complications or recurrences of the perineal hernias were reported. This clinical report shows that perineal hernias occur in chinchillas and can be surgically treated with success.     

Perineal hernia because of retroflexion of the urinary bladder in a rottweiler bitch during pregnancy

A young pregnant rottweiler bitch was presented with a large mass of tissue protruding through the vulvar lips. Foetal death was diagnosed on ultrasonography, and ovariohysterectomy was performed, at which time the bladder was observed to be dislocated caudally into the pelvic cavity under the vagina. The bladder was manually repositioned during surgery. One week later, the bitch was healthy with no evidence of dysuria, stranguria or urinary incontinence. Two months later, the owner reported that the bitch was clinically normal with no recurrence of the retroflexion. To the authors' knowledge, this is the first reported case of retroflexion of the urinary bladder during pregnancy.     

Urethrolithiasis and nephrolithiasis in a horse.

A 9-year-old, quarter horse gelding with obstructive urethrolithiasis was treated with a perineal urethrostomy. The horse's condition deteriorated and abdominocentesis confirmed septic uroperitonitis. The horse was euthanized and postmortem examination revealed peritonitis, a tear in the lateral wall of the bladder, and a nephrolith within the left renal pelvis.     

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.     

Perineal urinary bladder diverticulum resulting in partial urinary obstruction in a rhesus monkey.

A 16-year-old rhesus monkey with perineal swelling and urinary obstruction was found to have a congenital urinary bladder diverticulum. Because the diverticulum was located at the trigone, its distention partially obstructed the urethra, resulting in incomplete voiding. The diverticulum was resected and did not redevelop.     

Clinical and Surgical Parameters in Dogs with Perineal Hernia Analysis of Results of Internal Obturator Transposition

The results of treatment of 31 dogs with perineal hernia by internal obturator muscle transposition were evaluated by comparing the clinical signs reported by the owner before surgery with those reported 11 or more months following surgery. The severity and frequency of pre- and postoperative clinical signs were categorized numerically, and composite scores were obtained for each dog. In addition, the dogs were examined 11 or more months following surgery. The presence or absence of an externally obvious perineal swelling was noted, and rectal examination was performed to detect rectal sacculation and the integrity of the pelvic diaphragm dorsal and ventral to a line drawn between the center of the anus and the ischiatic tuberosity. These results were correlated with the postoperative composite scores. Postoperative complications included wound infection (2), wound seroma (2), rectal prolapse (4), urinary incontinence (2), and flatus as a new postoperative problem (11). The postoperative composite score was significantly lower (improved function) following surgery. Dogs with worse signs preoperatively or bilateral perineal hernia benefited less from surgery. More dogs showed improvement when the operation was performed by experienced surgeons. Factors detected at follow-up examination that correlated with more severe postoperative clinical signs were perineal swelling, absence of the ventral portion of the pelvic diaphragm, and rectal sacculation. The presence or absence of reformation of the dorsal aspect of the pelvic diaphragm did not correlate with postoperative clinical signs.