Exam 3 - Perineal Urethrostomy

Question 1

what is the goal of doing a perineal urethrostomy?

Answer 1

eliminate/reduce urethral obstruction in cats with FLUTD

Question 2

T/F: it is reasonable to do a PU surgery on a blocked tom

Answer 2

false - patient isn’t stabilized!!! surgery is done on stabilized patients

Question 3

when do we do perineal urethrostomy surgeries?

Answer 3

on male cats!!!!!

use the 3 strike rule typically - recommended on the 3rd obstruction

or if an owner can’t handle a blocked cat at all

Question 4

what complications are associated with PU surgeries? what causes them?

Answer 4

stricture - caused by too much tension!! usually at the surgical site when penile urethra isn’t freed enough

subcutaneous leakage of urine - you don’t have perfect apposition of the skin & urethral mucosa

hemorrhage

UTIs

incontinence

Question 5

what is the most common complication seen with PU surgeries? why?

Answer 5

UTIs!!!

male animals originally have a long urethra, but we are shortening it!!! predisposes them to getting an infection!!

Question 6

how should an animal be prepped for a PU surgery?

Answer 6

wide clipping of the abdomen!! may need to do a concurrent cystotomy

a lot of shaving around the prepuce specifically

Question 7

what is shown here in this photo for prep of a patient prior to PU surgery? why is it done?

Answer 7

purse string suture is placed into the rectum

prevents fecal material from leaking out & contaminating your surgical field

Question 8

what positioning of the patient is done for a PU surgery?

Answer 8

can be dorsal or sternal - likely to see it done more commonly in dorsal recumbency

pelvis is tilted up & a roll of gauze or foam is placed under the bottom to tilt it up - legs are pulled towards the head to further elevate the pelvis

Question 9

what should you do prior to a PU surgery in an intact male cat?

Answer 9

need to castrate them prior to doing the incision to start the PU

Question 10

where is the incision made for a PU?

Answer 10

around the prepuce, elliptical shape

staying at least 1 cm ventral of the anus!!!

Question 11

what is the benefit of leaving a urinary catheter in place when doing a PU surgery?

Answer 11

makes feeling the urethra a lot easier

Question 12

after making the incision around the prepuce when starting a PU surgery, what is the first step?

Answer 12

dissection down towards the urethra is done

Question 13

after dissection has been done in a PU surgery to get down to the urethra, what is done next?

Answer 13

traction is placed on the penis/prepuce pulling it caudally so you can identify the ischiocavernosus muscles

Question 14

what do the stars represent in the photo on the left? what do the dashed lines represent in the photo in the middle?

Answer 14

left - origin of ischiocavernosus muscles just off of the ischium & where you cut them!

middle - ventral ligament of the penis, also needs to be cut

Question 15

what is so important about cutting the ischiocavernosus muscles & ventral ligament of the penis?

Answer 15

you need to free up the penile urethra or else you will cause too much tension & strictures will happen!!

Question 16

how do you check that you have freed the attachments of the ischiocavernosus & ventral ligaments of the penis when doing a PU surgery?

Answer 16

take a finger and poke on either side of the penis - finger should sink in

if it doesn’t indicates that you need to free it up more

Question 17

what do the stars represent? what do the “B’s” represent?

Answer 17

stars - ischiocavernosus muscles

Bs - bulbourethral glands

Question 18

what is the importance of the bulbourethral glands in a PU surgery?

Answer 18

they mark the proximal extent of your dissection & proximal extent of your incision!!

Question 19

what marks your incision into the urethra in a PU surgery? how do you go about making your incision?

Answer 19

retractor penis muscle is right on midline of the penile urethra marking your incision

need to get the retractor penis muscle out of the way, can transect/dissect

incision is made into the penile urethra using an 11 blade & then switching to tenotomy scissors extended to go between the bulbourethral glands

Question 20

how big does your incision into the urethra need to be?

Answer 20

big enough to pass the box locks of mosquito hemostats

Question 21

what are the critical sutures after you have made your urethral incision?

Answer 21

sutures that will connect the skin to the urethral mucosa!!!!

starts at 6pm (closest to the butt hole) - suture about 2mm apart ensuring that you are getting perfect apposition between the skin & mucosa of the proximal portion of the urethra!!!!!

Question 22

what happens if you get subcutaneous tissue stuck between your skin & urethral mucosa sutures?

Answer 22

you don’t get perfect apposition & this will result in urine leakage into the subcutaneous space!

Question 23

after your critical sutures are placed, how are the remaining sutures done?

Answer 23

can be simple continuous - these are used as a drain board for urine to drain out of ventrally - not as important as your critical sutires!!!

Question 24

after your critical sutures & draining board sutures have been placed, what is the next step in a PU surgery?

Answer 24

penis & prepuce are ligated/amputated

Question 25

what makes up post-op care for PU surgery patients?

Answer 25

ECOLLAR!!!!!!!!!

do not wipe, blot, dab, or clean incision!!!!

long term - monitor for UTIs

Question 26

why does the owner of a cat that had a PU surgery need to know the signs of UTIs?

Answer 26

they will now be predisposed to getting them because they have a much shorter urethra now!!!