Surgery Of The Urethra

Question 1

What is the most common developmental abnormality of the male genitalia?

Answer 1

Hypospadias —> incomplete formation of penile urethra

—> urethral orifice can occur along anywhere along penis

Question 2

Dogs predisposed to hypospaidas?

Answer 2

Boston terrier

Question 3

Signalment associated with urethral prolapse ?

Answer 3

Young brachycephalic male

Ex unknown
-sexual excitement/dyspnea/infection

Question 4

Clinical signs of urethral prolapse?

Answer 4

Bleeding from prepuce
Licking
Red-purple mass

Question 5

What is the treatment for a prolapsed urethra that is necrotic or ulcerated?

Answer 5

Resection and anastomoses

—> catheterize
—> tourniquet (keeps penis extruded, controls bleeding)
—> 180 degree incision (prevent mucosal retraction )
—>suture

Question 6

What suture should be used for urethral surgery ?

Answer 6

Monofilament (eg PDS)

Avoid braided

Question 7

What are the pros and cons to catheter placement in urethral surgery?

Answer 7

Pro - divert urine

Con - comprise healing and narrows lumen

Question 8

Where can you have urine accumulation due to urethral trauma?

Answer 8

Abdomen, pelvic canal, or SQ tissue

Question 9

What are clinical signs of urethral trauma?

Answer 9

Hematuria
Stranguria
SQ or abdominal fluid
Azotemia

Question 10

How can you diagnose urethral trauma/tears?

Answer 10

Positive contrast urethrogram

Question 11

Treatment for urethral tears?

Answer 11

Incomplete/small lacerations will heal with urinary diversion with catheter or cystostomy tube

Duration of catheterization is dependent on severity - minimum 3 weeks

Question 12

Urethral is completely ruptured.. how to treat?

Answer 12

Anastomosis or repair with urinary diversion

Question 13

Common place for urethral stones in males?

Answer 13

Ischial arch/cd penis

Stones

Question 14

Goals of treatment for urethral obstruction?

Answer 14

Renal function/uremia

Electrolytes —> often have metabolic acidosis and hyperkalemia (give hypertonic NaCl)

Temporarily relieve obstruction

• catheter
• hydropropulsion
• cystocentesis

Treat UTI
Prevent reoccurrence

Question 15

When is surgery indicated for urethral obstrucion?

Answer 15

Multiple episodes
Urethral damage
Stricture formation

Cystotomy after hydropropulsion
Urethrotomy if hydropropulsion unsuccessful

Often cystotomy combined with urethrotomy

Question 16

Indications for urethrotomy?

Answer 16

Calculi that cannot be hydropropulsion

Cystotomy preferred

Question 17

What is the most common location for a urethrotomy in dog?

Answer 17

Prescrotal

Question 18

Where do you make your incision for a prescrotal urethrotomy?

Answer 18

Ventral midline between base of scrotum and caudal penis

Question 19

What muscle must you retract in prescrotal urethrotomy?

Answer 19

Retractor penis muscle

Question 20

Why is prescrotal urethrotomy preferred to other sites?

Answer 20

Less risk of hemorrhage -> less cavernous tissue

This is common site of obstruction

Question 21

What size and type of suture will you used to close urethrotomy?

Answer 21

4\0 or 5\0 monofilament absorbable

Question 22

Why might you want to allow your urethrotomy site to close by second intention?

Answer 22

Less risk of stricture

Question 23

What approach would you do if your calculi are lodged between scrotum and ischial arch?

Answer 23

Perineal urethrotomy

Question 24

Why do we want to avoid perineal urethrotomy?

Answer 24

Difficult procedure —> deeper urethra, past bulbospongiosus m and corpus spongiosum

Increase risk of infection (under anus)

Have to suture urethrotomy incision

Question 25

What is a urethrostomy??

Answer 25

Forming a permanent opening of the urethra at a new site

Question 26

Indications for a urethrostomy ?

Answer 26

Permanent damage
Recurrent urethral obstruction
Obstruction that cannot be retropulsed or moved by urethrotomy

Question 27

What are possible urethrostomy locations for dogs?

Answer 27

Scrotal (preferred)
Prescrotal
Antepubic
Perineal

Question 28

What are locations for urethrostomy in cats?

Answer 28

Perineal

Antepubic q