Urethral Disease

Question 1

How can the penile urethra be divided?

Answer 1

Perineal
Scrotal
Pre Scrotal

Question 2

Which are of the male urethra is most commonly used for performing permanent urethostomy?

Answer 2

Scrotal region

Question 3

What is the goal of urethral obstruction/trauna?

Answer 3

Regain urethral continuity and/or ability to redirect urine flow externally.

Question 4

What uroliths are amenable to dissolution?

Answer 4

Struvite
Urate
Cysteine

Question 5

Why is dissolution not an option in male dogs?

Answer 5

Risk of life threatening obstruction

Question 6

What are non surgical cystolith removal option? (4)

Answer 6

• Diet
• Voiding hydorpulsion
• Transurethral cystoscopic retrieval
• Lithotripsy

Question 7

What is the approach to a proximal urethral lesion?

Answer 7

Midline celiotomy

Question 8

What is the approach to a intrapelvic urethral lesion?

Answer 8

Pelvic osteotomy

Question 9

What is the approach to a perineal/penile urethral lesion?

Answer 9

urethrostomy proximal to the lesion

Question 10

What suture method/material for primary urethral repair?

Answer 10

Simple interrupted - monofilament/absorbable

Question 11

How can we support primary urethra repair? (2)

Answer 11

Tube cystotomy
Urethral catheter

Question 12

Is recurrent obstruction from urolith more common in dogs or cats?

Answer 12

Dogs

Question 13

Which urolith has highest rate of recurrence?

Answer 13

Calcium oxalate

Question 14

How often does struvite recur in:
A) Dogs?
B) Cats?

Answer 14

A) 21%
B) 2.7%

Question 15

Why should a urethrotomy be avoided where possible (2)

Answer 15

• Haemorrhage
• Urethral stricture

Question 16

What is the preferred location of urethrotomy?

Answer 16

Pre scrotal

Question 17

What muscle is retracted to allow urethrotomy?

Answer 17

Retractor preputial muscle

Question 18

How is the urethra incised?

Answer 18

Longitudinally

Question 19

Why is it important to remain on the midline of urethrotomy?

Answer 19

The ischiocavernosus tissue is present on each side of the urethra.

Question 20

How can urethrotomy be closed?

Answer 20

4-0 or 5-0 monofilament absorbable suture in a simple interrupted or continuous pattern

Question 21

What anatomy needs to be included when suturing urethrotomy? (2)

Answer 21

Urethra mucosa
Tunica aluginea

Question 22

Following a urethrotomy; for how long is haematuria expected?

Answer 22

4-5days

Question 23

When should a urethostomy be considered?

Answer 23

recurrent obstructions or if primary repair of the urethra is not feasible,

Question 24

What is a urethrostomy?

Answer 24

This procedure involves creating a permanent stoma in a wider part of the urethra to allow stones to pass out during urination or, in case of urethral rupture to anastomose the viable part of the urethra directly to the skin

Question 25

What urethrostomy is preferred in male dogs?

Answer 25

Scrotal

Question 26

Why is the scrotal urethrostomy a preferred site in males? (2)

Answer 26

Superficial and wide urethra here Less haenorrhage

Question 27

Most common short term urethrostomy complication?

Answer 27

Stricture formation

Question 27

What urethrostomy is preferred in male cats?

Answer 27

Perineal

Question 27

How to limit stricture formation?

Answer 27

Correct length and width

Question 28

Long term urethrostomy complications (3)

Answer 28

- Urinary incontinence - UTI - Urine scalding

Question 29

What muscle is retracted in a scrotal urethosotomy?

Answer 29

Retractor penis

Question 30

Steps for scrotal urethostomy?

Answer 30

- The dog is positioned in dorsal recumbency and a dog urinary catheter placed in the penile urethra up to the obstruction to facilitate identification of the urethra. - An elliptical incision is made in the scrotal region, and the subcutaneous tissues are dissected until the penile shaft is identified. - The retractor penis muscles are retracted laterally to expose the purple-coloured urethra surrounded by corpus - An incision is made over the urinary catheter (if possible) using a no. 15 blade. Bleeding will occur when the corpus spongiosum is incised, which can be controlled with direct pressure.spongiosum. The obstructive material is removed (if possible), and the catheter advanced into the urinary bladder to confirm patency. The urethral mucosa is sutured to the skin. Bites can include the tunica albuginea but not the corpus spongiosum.

Question 31

How to perform scrotal urethrostomy if entire?

Answer 31

Castrate/scrotal ablation first

Question 32

What suture/pattern is used to close scrotal urethrostomy?

Answer 32

A simple interrupted or simple continuous pattern can be used (absorbable or nonabsorbable monofilament).

Question 33

What layers should bites NOT include in scrotal urethrosotomy?

Answer 33

Corpus spongiosum

Question 34

What layers should bites include in scrotal urethrosotomy?

Answer 34

Tunia albuginea

Question 35

How is a cat positioned for perineal urethostomy?

Answer 35

Ventral recumbency

Question 36

How is the incision made in a perineal urethosotomy?

Answer 36

An elliptical incision is made in the scrotal and preputial region (if the cat is entire, castration is needed), and the subcutaneous tissues are dissected until the penis is identified.

Question 37

How is the penis reflected in a perineal urethostomy?

Answer 37

Dorsally

Question 38

Perinneal urethostomy: A) What ligament is cut? B) What muscle attachements are cut?

Answer 38

A) Ventral penile lig B) Ischio cavenrous

Question 39

What glands when exposed reveal with widest portion of the urethra during perineal urethostomy?

Answer 39

Bulbous urethalis glands

Question 40

How and what is sutured during a perineal urethostomy?

Answer 40

Suture urethral mucosa to skin with 4-0 to 5-0 monofilament absorbable or not, simple interrupted or simple continuous.

Question 41

What is retrohydropulsion?

Answer 41

Retrohydropulsion is indicated in cases of urethral obstruction, in order to propel obstructive material back into the bladder.

Question 42

How to perforn retrohydropulsion?

Answer 42

A catheter coated with sterile aqueous lubricant is introduced into the urethra distal to the obstruction. Sterile saline is injected into the catheter firmly, at the same time compressing the pelvic urethra per rectum. This allows the urethra to distend and frees up stones from the crevices of the collapsed urethral wall. The digital pressure should then be suddenly released while flushing is still maintained, in order to propel the material into the bladder.

Question 43

Retropulsion with sterile saline, how much: A) Dog? B) Cat/Small dog?

Answer 43

A) 50ml B) 10/20ml

Question 44

What should happen if its unable to relieve obstruction via retropulsion?

Answer 44

If it is not possible to relieve the obstruction, cystocentesis may be performed and retrohydropropulsion tried again 12 hours later, or a temporary urethral diversion can be placed i.e. tube cystostomy (surgical or minimally invasive using a pig tail catheter).

Question 45

When is urethral stenting used?

Answer 45

The relief of malignant (for e.g., transitional cell carcinoma) or benign (proliferative urethritis, urethral strictures) urothelial obstructions in the urethra.

Question 46

What breeds are predisposed to urethral prolapse?

Answer 46

1. English Bulldog - Boston terrier, Yorkshire terrier

Question 47

How to surgically correct a urethral prolapse?

Answer 47

The definitive treatment is surgical and consists in either a resection of the protruded part of the urethra or a urethropexy using vertical mattress sutures (2/0 to 3/0) monofilament absorbable.

Question 48

What pattern for urethral anastomosis following resection?

Answer 48

Simple continuous Triangulation technique - 3 series 120 degrees apart

Question 49

How is a urethropexy performed?

Answer 49

A groove director is placed in the urethra. Using a 2/0 to 3/0 monofilament absorbable suture with a long swaged-on needle, pass the suture from the penis to the urethral opening using the groove director as a guide then pass the needle in reverse fashion (vertical mattress suture) exiting only a few millimetres distal to the initial entry site. The sutures are not removed.

Question 50

Suture patten for urethropexy?

Answer 50

Vertical mattress suture to perform a pexy of the prolapse portion of the urethra. A groove director is used to push and maintain the prolapsed mucosa back in and guide the direction of the needle and suture. Two to three sutures are usually needed.