surgical diseases of urethra

M dog urethra - sections

prostatic → pelvic/ membranous → penile/ cavernous

M dog urethra - location of pelvic sectioon

prostate → ischial arch

M dog urethra - location of penile section

os penis groove

F SA urethra- where does it enter vestibule

2-5mm cd to vaginovestibular junction (dor wall close to ven vagina)

F vs M urethra - which can distend more + why

F - wider, folded mucosa, no bone

congenital urethral abnormalities - (Hypospadias, epispadias) what happens + how to treat

incomlete formation of urethra, cleft scrotum, incomplete prepuce formation, hypoplastic penis

resect hypoplastic penis

congenital urethral abnormalities - (urethrorectal fistula) what happens + how to treat

communication between urethra + rectum persits (foetal cloaca) → urine passed from anus + vulva/penis

resect fistula

acquired urethral lesions

urethritis

urethral prolapse

urethral obstruction

neoplasia

stricture

urethritis - associated with what

urogenital infl (cystitis, prostatitis, vaginitis)

urethral calculi, iatrogenic, neoplasia

urethritis - leads to

stricture, urethral prolapse

urethritis - CS + treatment

same as underlying disease

urethral prolapse - causes

urethral inf, sex

urethral prolapse - CS

excessive licking

protruding urethral mucosa

profuse intermittent bleeding

urethral prolapse - treatment

string suture around penis

resect prolapsed tissue + suture to urethra

castration

Issues due to urethral obstruction

Fail to eliminate urea + K

Hyperkalaemia → arrhythmias

Permanent renal damage

Pain

Bladder stretch

Causes of urethral obstruction

Urethral calculi

Urethral plugs

Prostatic disease

Hernia + body wall rupture → bladder displacement

Urethral neoplasia

Urethral stricture

Os penis fracture

Blood clots

Granulomatous urethritis

Urethral obstruction CS

Stranguira

Dysuria

Anuria

Haematuria

Excessive licking

Incontinence

Inappetance, lethargy, V

Abd distension, pain

Collapse

Urethral obstruction diagnosis

History

Abd palp - large, firm bladder

Serum biochem - urea, creatinine, K

Radiography - plain, positive contrast urethrography

US

What can positive contrast radiography detect in urethral obstruction

Displaced bladder, radiolucent calculi, soft tissue lesions

Urethral obstruction management

Empty bladder, IVFT, electrolyte balance, pain relief

Investigate cause

Urethral obstruction management- from calculi

1- empty bladder (cystocentesis)

2- IVFT

3- urethral catheter - GA, saline flush

4- empty bladder

5- retrograde urethrogram to confirm patency

6- cystotomy to retrieve calculi

Urethrotomy in M dog steps - urethra incision for surgical exploration

1- Catheter to obstruction

2- ven long midline incision cd to os penis

3- reflect retractor penis

4- longitudinal incision through urethra over calculus

5- remove + analyse calculus

6- advance catheter

7- suture shut

8- remove catheter

Urethrotomy - suture pattern to close

1.5 G monofilament absorbable suture

Simple interrupted/ continuous

Complications of urethrotomy

Haemorrhage

Corpus spongiosum haemorrhage if off midline cut

Urine into sc tissues

Stricture formation

Urethrostomy def

Create permanent urethral opening

When to do urethrostomy

Failure of retrograde flush for urethral calculi

Recurrent urolithiasis

Urethral stricture

Severe penile trauma

Urethrostomy - sites + species

Scrotal - dogs, less cavernous tissue

Pre scrotal - dogs

Perineal - cats

Pre pubic - intrapelvic urethral rupture in cats + dogs

Scrotal Urethrostomy - steps if not castrated

1- castrate

2- scrotal ablation

3- midline incision 3-4cm long

4- reflect retractor penis

5- 3-4cm incision along urethra

6- suture urethra to skin

7- close skin + sc tissue cd +cr to stoma

Scrotal Urethrostomy - Steps if castrated

1- midline incision 3-4cm long

2- reflect retractor penis

3- 3-4cm incision along urethra

4- suture urethra to skin

5- close skin + sc tissue cd +cr to stoma

Scrotal Urethrostomy - Closure

1.5 G monofilament suture in simple interrupted/ continuous

Scrotal Urethrostomy - What to do if non absorbable suture

Sedate in 14d for removal

Urethral obstruction in M cats - main location

Dist penile urethra - narrows

Perineal urethrostomy in M cats - when to do

Fail to relieve urethral obstruction by retrograde flushing

Recurrent / chronic urethral obstruction

Penile urethral stricture

Severe penile urethral trauma

Perineal urethrostomy in M cats - Complications from surgery

Wound breakdown

Cellulitis

Stricture formation

Recurrent UTI

Perineal hernia

Urethral trauma - causes

Abd Trauma, pelvic fracture, iatrogenic (catheter)

Urethral trauma - CS

Haematuria, dysuria, anuria

Pain

Abd distension

Inappetence, lethargy, V

Collapse

Skin discolouring, cellulitis of perineum+thigh+cd abd

Urethral trauma - Diagnosis

History

Radiography (Plain, retrograde urethrogram)

Serum biochem - inc urea, creatinine, K

Urethral trauma - Treatment

Establish patency with catheter

Stabilise patient

Conservative treatment - in dwelling catheter

Surgery

Prepubic urethrostomy - steps

Salvage procedure for intrapelvic injury if not enough length

Create new opening on ven cd abd