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.     

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.     

Creation of a Urethral Conduit from a Preputial Indirect Flap in a Dog with Perineal Hypospadias

Objective— To report a surgical technique for creation of a urethral conduit using a preputial indirect flap.
Study Design— Case report.
Animals— Male Doberman Pinscher (6 weeks old).
Methods— A urethral conduit was constructed using a multistage preputial indirect flap in a dog with severe perineal hypospadias.
Results— Successful transfer of a perineal located urethral meatus to a more anatomically normal inguinal location was achieved with a preputial flap. The procedure was performed to aid control of recurrent urinary tract infections after anal and urethral separation in a dog with imperforate anus, urethrorectal fistula, and proximal perineal hypospadias.
Conclusions— Creation of a urethral conduit from a tubed bipedicle flap using redundant preputial tissue eliminated fecal contamination of the urethral meatus, aiding control of urinary tract infection. A good functional and cosmetic outcome was achieved.
Clinical Relevance— This technique should be considered in aiding control and prevention of urinary tract infections in dogs with proximal perineal hypospadias where a preputial remnant exists.     

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.     

Perineal urethrostomy versus dietary management in prevention of recurrent lower urinary tract disease

The frequency and cause of recurrent lower urinary tract disease was compared prospectively in three groups of 10 male cats during a one year period following correction of obstructive urethropathy caused by matrix-crystalline plugs. One group of cats was managed by perineal urethrostomy, one group with a calculolytic diet, and the third group by perineal urethrostomy and the calculolytic diet. Ten episodes of bacterial urinary tract infection developed in five of 10 cats with perineal urethrostomies; six episodes of bacterial urinary tract infection developed in four of 10 cats with perineal urethrostomies and consuming the calculolytic diet. Bacterial urinary tract infections were not observed in cats managed only with the calculolytic diet. Staphylococcal-induced struvite urocystoliths developed in two cats with perineal urethrostomies. Vesicourachal diverticula detected in nine cats at the time of diagnosis of urethral obstruction healed spontaneously following restoration of urethral patency and remission of clinical signs. Transient microscopic haematuria was observed in approximately 25 per cent of the cats in all three treatment groups during the one year study. Results of this study confirm the effectiveness of dietary management in prevention of recurrent urethral obstruction caused by struvite-containing urethral precipitates, and verify that recurrent signs of lower urinary tract disease in cats may be caused by agents that are different from those that initiate the problem. They also confirm that perineal urethrostomies predispose cats to recurrent ascending bacterial urinary tract infections.     

Laparoscopic‐assisted tube cystotomy for urethral rupture in a foal

A 10‐day‐old Tennessee Walking Horse colt was hospitalised due to a pelvic urethral tear. After 2 unsuccessful attempts to repair the tear by primary closure, the colt underwent perineal urethroplasty and laparoscopic‐assisted tube cystotomy which permitted complete urine diversion and allowed the urethral tear to heal completely.     

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.     

Rectum diverticulum/perineal hernia surgery through longitudinal contracting of the wall of the rectum

Older male dogs often exhibit the symptoms of rectum diverticulum and perineal hernia. In order to point out the often common reason of these disorders, the term "rectum diverticulum/perineal hernia complex" has been introduced. In a large group of such patients two methods of surgical correction of this problem were retrospectively evaluated. Only patients were included in this evaluation that were euthanized if recurrence occurred. In 21 patients (group 1) the often performed method of Bojrab was used, both in rectum diverticulum and in perineal hernia operations. In group 2 15 dogs were subjected to the same operation technique, but we performed an additional pleating contraction of the herniated gut wall layers. In case of visible recurrence at an age of at least 11 years the dogs were euthanized. Group 1 showed a postoperative survival time of 3.61 +/- 0.96 years until recurrence, group 2 revealed recurrence not before 4.93 +/- 0.93 years post operationem. The difference is significant (p < 0.05). It is the opinion of the authors that additional longitudinal contracting by pleating of the gut markedly prolonges the point of time when recurrence appears.     

Acute gaseous peritonitis after rupture of a retroperitoneal rectal diverticulum in a dog

An 11-year-old, entire male coton de tulear was presented on emergency with acute and severe depression, acute abdominal pain and vomiting of 24 hours duration. Historical complaints included right perineal swelling, dyschezia and tenesmus of 18 months duration. Abdominal ultrasonography and radiography suggested a pneumoperitoneum and positive-contrast colonography showed leakage of contrast medium into the caudal abdomen and the presence of a large retroperitoneal pouch. Exploratory laparotomy allowed the visualisation of faecal leakage from the retroperitoneal space into the peritoneal cavity. Using a perineal approach, a large necrotised rectal diverticulum filled with faeces was found over the retroperitoneal structures. A standard herniorrhaphy was then performed. The dog recovered uneventfully and dyschezia did not recur at the nine month follow-up. Rectal diverticulum rupture associated with peritonitis has not been described in the veterinary literature, to the authors' knowledge, and should be considered as a rare differential diagnosis in dogs being presented with gaseous peritonitis.     

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.     

Medical management of urethral and colonic perforation associated with urinary catheterization in a kitten

A 6-week-old male kitten was evaluated because of stranguria and possible urethral blockage; a urinary catheter placed during general anesthesia penetrated the urethral and colonic walls and entered the colon. Treatment was conservative, with fluids administered i.v., administration of piperacillin, and supportive care. The kitten never became febrile or clinically ill and continued to thrive. There was no development of clinical signs consistent with stricture, diverticulum, or fistula formation. Complications from urethral perforation include infection and urethral stricture. Reconstructive surgery is considered the treatment of choice for traumatic urethral-colonic perforation. However, surgery may not be feasible or may be cost-prohibitive in certain situations. In such instances, medical management may provide a reasonable alternative to euthanasia.     

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.     

Rectal Diseases and Their Role in Perineal Hernia

Rectal abnormalities frequently coexist with perineal hernia. The three commonly recognized are deviation, sacculation, and diverticulum. If not corrected, these problems may lead to incomplete rectal emptying at defecation, persistent straining, and breakdown of the herniorrhaphy. Diagnosis of these abnormalities is by physical examination, with confirmation by barium enema. Amputation of rectal sacculations was performed during perineal herniorrhaphy on four dogs, three of which had previously had multiple recurrences of perineal hernia. None of the four experienced further straining or reherniation during a 12 to 16 month period following surgery.     

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.     

Use of fluoroscopically guided percutaneous antegrade urethral catheterization for the treatment of urethral obstruction in male cats: 9 cases (2000-2009)

Objective-To describe the technique and determine outcome for male cats with urethral obstruction treated with fluoroscopically guided percutaneous antegrade urethral catheterization (PAUC). Design-Retrospective case series. Animals-9 client-owned neutered male cats with urethral obstruction and inability to pass a retrograde urinary catheter. Procedures-Information regarding the procedure and hospitalization was obtained from medical records. Long-term follow-up was obtained via medical record review or telephone interview. Results-Diagnoses included iatrogenic urethral tear (n = 6), obstructive urethral calculi (1), urethral ulceration (1), and urethral stricture (1). Seven of the 9 procedures were successful. The 2 patients in which PAUC failed had mechanical obstructions preventing guide wire access across the urethral obstruction. Procedure times ranged from 25 to 120 minutes. No complications were noted in any patients during the procedure. One patient was euthanized because of unrelated disease. Follow-up information was available for 6 of 8 surviving patients. No complications that could be directly attributed to the procedure were noted. All 6 patients had a perineal urethrostomy performed 0 days to 6 weeks following the procedure because of reobstruction of the lower urinary tract. None of these patients had documented urethral strictures and none had recurrence of clinical signs following perineal urethrostomy. Conclusions and Clinical Relevance-Results suggested that PAUC can be a simple, rapid, minimally invasive, and safe technique to facilitate transurethral catheterization in select cases. Patients with iatrogenic urethral tears may be good candidates. Patients with impacted urethral calculi, severe strictures or ulcerations, or a nondistended urinary bladder may be less amenable to PAUC.     

An unusual case of urinary incontinence in an intersex West Highland white terrier

A 5-year-old neutered female West Highland white terrier dog was presented with a history of congenital urinary incontinence that had become refractory to medical management. Complex urogenital anomalies including urethrovestibular and vestibuloperineal fistulae with low vulvar position along with a penoclitoris were present. Vaginectomy with perineal urethral reconstruction resolved the incontinence.     

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.     

Urethrotomy and urethrostomy in the dog

An incision, or urethrotomy, is made into the urethral lumen to remove or relieve an obstruction temporarily. When permanent diversion of urine flow proximal to an obstructed, severely damaged, or diseased urethra is required, a urethrostomy is performed. Urethrostomy is also performed to diminish the risk of urethral obstruction due to recurrent urinary calculi that are not likely to be resolved with medical therapy. Whenever possible, to reduce the risk of urethral stricture or recurrent urinary tract infection, urethral surgery is avoided when an obstruction can be relieved by retrohydropropulsion or catheterization. Urethrotomy can be performed in the prescrotal or perineal regions depending on the level of the urethral obstruction. Although urethrostomy can be made in the perineal and antepubic positions, scrotal urethrostomy is the procedure of choice provided the lesion is distal to this area. Specific urethrotomy and urethrostomy procedures are described, including discussion about selection of the appropriate procedure for the urethral problem, patient stabilization considerations, general postoperative management, and risk of 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.