I'm the proud owner of two dogs: a Chihuahua-Papillon cross and an American Staffordshire. I am an animal lover and advocate in general.
A canine urethrostomy is a very invasive and permanently life-altering procedure. If your dog is unfortunate enough to have this surgery, it was likely imperative to save their life. So whilst the recovery is an emotional journey for both you and your pet, try to remain positive.
Enjoy the second chance the procedures given the both of you. My Staffy is roughly five years post-op and has had no issues relating to his surgery. With a lot of love and care, life after this procedure can be just as good as before.
Recovery After a Urethrostomy
After the initial urethrostomy procedure, a dog is usually kept in a veterinary hospital. However, this is not always the case and it certainly wasn't for us. My dog was released just hours after the surgery, and the aftermath was brutal for the first few weeks. Owners should be aware that this will be an emotional time for both their pets and themselves.
Is Bleeding Normal?
Bleeding heavily from the operative site is absolutely normal but definitely scary as well. Bleeding and healing will vary with each individual dog depending on things like breed, behaviour, age, and general well-being of the animal. My American Staffordshire did not have a smooth recovery. Being a young dog with an energetic nature, it was near impossible and very difficult to keep him rested. But that's the most important thing to do—to keep your dog as calm and immobile as possible.
Keep the Wound Clean
Hygiene, particularly of the wound itself, is key. Dogs should be kept indoors where possible and cleaned effectively, several times a day and after urinating and defecating. I found baby wipes particularly useful during the recovery period as well as after! Unfortunately, dogs rarely urinate in a steady single stream after a urethrostomy. It becomes more like a sprinkler and often will end up getting all over your pet's legs and feet, which is not good for their skin. So wipes are handy to avoid further skin conditions developing as a result.
Problems During Recovery
Dogs typically take six weeks to fully heal from a urethrostomy. Unless, of course, there were problems such as sutures being reopened or wounds compromised by infection. We will address some of the common problems as well.
Keeping the Surgical Site Clean
Stitches can reopen and the operative sight can experience trauma in so many ways. Keeping your pet immobile enough to heal is problematic for a lot of owners. The dog might be excitable and energetic, and reluctant to stay still. The wound can be itchy and your dog might scratch at the wound or grind on the ground. For any trauma, return to the vet who performed the surgery immediately. They will assess the damage and decide what action is necessary.
Infections during recovery should be prevented with antibiotics prescribed by your vet. Whilst uncommon, they are not impossible. If the operative sight begins to look red, swollen or oozy, do take note. Return to your operative vet and they will assess the infection and prescribe antibiotics. For more severe infections or instances of foreign matter being present, they may wish to reopen the sight and clean it.
With any and all concerns post-surgery, the advice is the same. Frequent communication with your vet is key. Do not hesitate to call them and raise any and all concerns.
Getting back to normal once healed can be a learning curve in itself for both you and your pooch. This section will assess aspects of returning to normality in terms of combining old routines with new challenges and care tactics.
Most Patients Are Male
Most dogs that require this procedure are male. Meaning they have likely become neutered as a consequence of the procedure if they weren't already. This can mean your dog may experience behavioural changes typical to male dogs after being desexed due to hormonal changes on top of anatomical changes.
Learning to Potty
Male dogs can no longer urinate as they did before either. Going from a steady stream and leg lifting to being a sprinkler and needing to squat are big changes for them. Most dogs will learn to squat instead of lifting their leg on their own in time. Some never will. For these owners, in particular, maintaining good doggy hygiene is imperative. I still to this day, baby wipe my dog after every trip outside.
Fur growing around or in the new urethral opening needs to be kept trimmed but not closely shaven. Long hair can get in the way of good hygiene. But shaving the hair close to the skin can result in ingrown hairs. I was very fortunate, my Staffordshire has naturally short hair so didn't need extra grooming however I do have to be careful loose hair of his doesn't venture into the urethral opening. Be sure to inspect the area frequently for any loose hair or other foreign materials such as grass or dirt.
Your pet should be able to play and walk as they did before surgery. Exercise is as important as ever for their well-being. So do not hesitate to take them out and about. Do be on the lookout though for 'grinding' behaviour or excessive scratching on grasses and carpets that might agitate the new urethral opening.
As with any operation, pets should continue to receive veterinary care and post-operative check-ups. This procedure might mean your dog is unlikely to have future problems with bladder stones, however, it may make your dog more susceptible to urinary tract and bladder infections. So doing a routine urine collection and analysis is worth the peace of mind.
How to Care for Your Dog After a Urethrostomy
This article is a follow up on a previous article and has limited detail on the procedure and recovery. For more information about the procedure and helping your pet through the initial recovery period, please read my article: "How to Care for Your Dog After a Urethrostomy."
© 2019 Stephanie Purser
Canine Urethrostomy Recovery - pets
Why Urinary Blockage is life-threatening?
The urethra is a tube-like structure that carries urine from the bladder to the outside of the body. Sometimes, mineral crystals or stones form in the urethra and block the path to the outside. The blockage is called a urethral plug. Because a male cat’s urethra is longer and narrower than a female’s, urethral plugs are most often seen in males (whether or not they are neutered). Once a plug has formed, urine builds up in the bladder. This is not only painful to the cat, but can quickly cause kidney damage. The kidneys’ job is to release poisonous wastes from the body when kidneys don’t function properly, these poisons accumulate in the bloodstream. The final result, if not treated: a painful death.
What does the perineal urethrostomy surgery entail?
The surgical procedure is called a perineal urethrostomy. Your veterinarian will remove much of the penis and the narrow portion of the urethra and leave a wider opening for the remaining portion under the anus. Your cat may be hospitalized for several days, and often a catheter will be left in place overnight or longer. Afterward, Kitty may be treated with antibiotics, urinary antiseptics, and urinary acidifiers. Post-operative care at home will require you to carefully observe Kitty and his potty habits.
Perineal urethrostomy will permanently cure urethral obstruction in 90 percent of male cats. The surgery does not affect the formation of crystals (which result in the plug to begin with), but provides a wider passageway for their release outside the body. Thus, blockages should not recur, but bladder infections might.
How to prevent Urinary Problems?
All cats should be encouraged to exercise and be kept at a trim, healthy weight. Feed your cat a high quality cat food that is low in magnesium. Entice him to urinate frequently by keeping his litter box clean and always accessible. He should have constant access to plenty of fresh water, as well if necessary, you can add salt (sparingly) to Kitty’s food to encourage him to drink more. If your cat is prone to obstructions, you may need to administer medications, Vitamin C, or a special diet to help keep his urine acidic. You can also increase his urine’s overall acidity by restricting feeding to twice daily. This is because the digestive process temporarily lowers the acidity, so every time Kitty eats, his urine becomes less acidic for awhile. In addition, have your veterinarian perform periodic urinalyses on Kitty. This will keep you and your veterinarian alert to the urine’s acidity level and to the presence of any crystal formations, so you can stop problems before they start.Be sure to discuss these and other preventative measures with your veterinarian, and get his or her approval before administering any medication or supplements to your cat.
How to help your cat live a long, full life?
Urethral obstruction in cats is becoming less common as more cats are routinely fed premium quality cat foods that discourage crystal formation. But Dr. Valerie Creighton, an AAHA veterinarian who specializes in feline medicine, reminds pet owners that the condition is an emergency situation.
"Urethral obstruction can rapidly become life-threatening over the course of just one to two days," says Dr. Creighton. "Because of this, any cat owner whose male cat is showing signs of frequent efforts of any kind in the litter-box is strongly urged to seek veterinary attention at once."
Now that you know what to look for, you can help ensure your cat’s good health by reacting quickly to signs of obstruction.
What are the indications for performing a perineal urethrostomy (pu)?
Urethrostomy is indicated when the urethral opening is too narrow or persistently obstructed. This procedure is most often used in male cats with feline urologic syndrome prone to urethral obstruction from protein plugs, bladder “sand”, or bladder stones that enter the urethra and obstruct urine flow. While some cats with these problems respond to diet and medication, others experience recurrent episodes of urinary obstruction. In these cats, surgery is the best treatment. Urethrostomy also is indicated in cases of severe penile trauma or scarring that does not allow for normal passage of urine.
What preoperative tests are needed before a urethrostomy?
Preoperative tests depend in part on the age and general health of the animal as well as the cause for the urethrostomy. If treatment for urinary obstruction is the cause, a packed cell volume (or complete blood count) should be determined and a serum biochemical profile test done to assess the kidney function and blood potassium. Often an abdominal x-ray or ultrasound of the bladder will be recorded. If the need for urethrostomy is related to major trauma to the area, more extensive tests such as radiographs (x-rays), blood count, serum biochemical tests, a urinalysis, and possibly an EKG may be necessary. Creation of the urethrostomy may even be delayed until the animal is stabilized.
What type of anesthesia is needed for a urethrostomy?
As in human patients, the procedure in cats requires general anesthesia to induce complete unconsciousness, relaxation, and relief of pain. In the usual case, the pet receives a pre-anesthetic sedative-analgesic drug to help him relax, a brief intravenous anesthetic to allow placement of a breathing tube in the windpipe, and inhalation (gas) anesthesia in oxygen during the actual surgery.
How is the urethrostomy operation done?
Following anesthesia, the pet is placed on a surgical table, typically lying on his abdomen with the perineum exposed to the surgeon. The hair is clipped around the area selected for the surgery. The surgery is done typically between the scrotum and the rectum. After clipping, the skin is scrubbed with surgical soap to disinfect the area. A sterile drape is placed over the surgical site, and a scalpel is used to incise the skin. Your veterinarian will have to dissect surrounding tissues until the urethra is exposed, and then will make an incision in the urethra and the penis. The surgeon will suture the edges of the urethra to the edges of the skin incision to create a wide urethral opening. Some surgeons choose to use absorbable sutures (stitches) that dissolve over time. Other surgeons use non-absorbable sutures that need to be removed in about 10 to 14 days. When the procedure is done to intact tomcats, castration is usually performed as the same time. That procedure is explained elsewhere on this site.
How long does the urethrostomy procedure take?
The procedure takes about 45 minutes to an hour in most cases, including the needed time for preparation and anesthesia. In cases of severe trauma or scarring, the procedure can take longer and may require two surgeons or referral to a board-certified surgical specialist.
What are the risks and complications of a Perineal urethrostomy Surgery?
The overall risk of this procedure in a healthy cat is very low. The major risks are those of general anesthesia, bleeding (hemorrhage), post-operative infection, and wound breakdown (dehiscence) over the incision. Scar formation occurs in some cats and leads to closing off the urethra. While the overall complication rate is low, a serious complication can result in death or the need for additional surgery.
What is the typical postoperative aftercare for a urethrostomy ?
Postoperative medication may be given to relieve pain, which is judged in most cases to be mild to moderate, and can be effectively eliminated with safe and effective pain medicines. The home care requires reduced activity until the stitches are removed in 10 to 14 days and preventing the cat from chewing or licking at the sutures. This may require a restraining collar around the neck for a week or two. Paper or plastic litter should be used in place of the normal litter material. If your cat does not object, you should inspect the area (with care) for signs of discharge and monitor your cat for normal urination. Any inability to urinate should be reported promptly to your veterinarian. After healing, the surgical area has a good cosmetic result. Recognize that the urine stream will no longer be oriented through the end of the penis (which has been removed), instead the cat will void across the surgical opening. This difference is not obvious to most people.
How long is the hospital stay?
The typical stay following urethrostomy surgery is 2-3 days but will vary depending on the overall health of the pet, kidney function, and his ability to urinate following surgery.
Indications for Cat Perineal Urethrostomy
Recurring Stone Blockage
Cat perineal urethrostomy is indicated when the urethral opening is too narrow or persistently obstructed. This procedure is most often used in male cats with feline urologic syndrome prone to urethral obstruction from protein plugs, bladder “sand”, or bladder stones that enter the urethra and obstruct urine flow. While some cats with these problems respond to diet and medication, others experience recurrent episodes of urinary obstruction. In these cats, surgery is the best treatment.
Tumors of Penis/Sheath
Cat perineal urethrostomy is also indicated in cases of severe penile trauma, tumors or scarring that does not allow for normal passage of urine.
The urethra is relatively long in male dogs (10 to 35 cm) and varies widely in length and width proximal to the os penis to permit distention with voiding and ejaculation. 39 It is divided into three segments: the preprostatic and prostatic sections that lie within the pelvic canal and the cavernous or membranous urethra (pars spongiosa). 39 The preprostatic segment extends from the neck of the bladder to the prostate, and the prostatic segment (pars prostatica) passes through the prostate gland. The cavernous portion of the urethra begins at the ischial arch, where the pars spongiosa is joined by the cavernous spaces of the bulbus penis that continue to the urethral termination (Figure 117-1). 39
In general, the urethra consists of a mucosal tube surrounded by a vascular submucosa and muscular tunic. Between 20% and 44% of urethral wall volume is connective tissue, and the urethral wall volume increases distally. 34 The urethral mucosa is composed of transitional epithelium that forms longitudinal folds when relaxed. The lining becomes stratified squamous epithelium near the external urethral orifice. 39 The submucosa consists of a series of vascular sinus channels within the cavernous segment, the urethral submucosa is a continuation of the vascular erectile tissue of the penile corpus spongiosum. 39 Surrounding the submucosa is a thin inner layer of smooth muscle that runs the entire urethral length. Smooth muscle bundles are primarily longitudinally oriented and are continuous with the capsule of the prostate. These taper distally, contributing 0.3% to 12% of the total urethra volume along its length. 34,116,117 Smooth muscle of the distal two thirds of the urethra is surrounded by thicker, circularly orientated striated (urethralis) muscle layer. 34 This muscle layer comprises 70% of the volume of the wall of the membranous urethra, and unlike in humans, does not diminish with age. 117 Functional striated muscle of the dog is reported to contain 3% to 19% of type I (slow-twitch) fibers, depending on breed and regional variation along the length of the urethra the remaining fibers are type II (fast-twitch). 117 Whereas the pudendal (somatic) nerve provides exclusive innervation to striated muscle of the membranous urethra, smooth muscle is innervated by the pelvic (parasympathetic) and hypogastric (sympathetic) nerves (Figure 117-2). 32 Urethral vasculature arises from branches of the internal pudendal vessels, including the prostatic, urethral, and penile arteries and veins. 39
In contrast to dogs, male cats have a distinct preprostatic urethra that contains three layers of smooth muscle fibers (circular and longitudinal) that contribute to a relatively long internal urethral sphincter. 36,119 Although the striated (urethralis) muscle in male cats is relatively thicker in cross-section than that in male dogs, it comprises a shorter functional length of the postprostatic urethra. 36 The urethra in male cats also has comparatively more elastic fibers and less stratum cavernosum than in male dogs, and this may contribute to passive urethral resistence. 36,119 The age at castration does not affect mature urethral diameter in male cats, although this effect has been reported in some species (cattle, goats, buffalo). 101
The urethra in female dogs (see Figures 117-2 and 117-3) is shorter and wider than in males and contains relatively more connective tissue (64% to 70% of total urethral volume). 33 Its smooth muscle consists of outer and inner longitudinally oriented layers and a middle circular layer. Circular smooth muscle occupies approximately 25% of the volume of the proximal urethral wall, and this muscle tapers distally and is nearly absent in the terminal urethra. 33 Smooth muscle interdigitates with striated (urethralis) muscle fibers in the distal third of the urethra. Striated muscle that remains separate from the pelvic floor completely surrounds the vagina and urethra at the urethral orifice. 111 Total musculature is significantly increased to 33% (22% striated 11% smooth muscle) of urethral wall volume in this region. 33
Histologic comparison of urethral composition in spayed and intact female dogs suggests that ovariohysterectomy decreases smooth muscle mass and connective tissue however, differences were only statistically significant between mean relative volumes in the proximal fourth of the urethra. 7 Other investigators found a significantly higher proportion of collagen and, consequently, less muscle tissue in the urethra of gonadectomized female dogs compared with intact dogs. 94 Female dogs, regardless of gonadal status, have significantly higher amounts of collagen and less muscle in the urethra than males. 94 Collectively, these findings suggest that steroidal hormones may influence morphology of the canine urethra, and this effect may be important in maintaining structural and functional integrity of the lower urinary tract relative to postneutering incontinence (see Chapter 119).
The relative length of the urethra of female cats is comparable to that of female dogs however, the lumen is relatively smaller. 35 The urethral wall of cats also contains an appreciable amount of longitudinal smooth muscle and less absolute volume of circular sphincteric muscle and elastic fibers relative to that of female dogs. 35 This disparity may influence urethral resistance and suggests that continence mechanics differ among species.
Initial management of patients with suspected urethral obstruction should include evaluation of hemodynamic status, correction of metabolic derangements (see Chapter 116), and urethral catheterization (Figure 117-4). An intravenous catheter should be placed and intravenous fluids and analgesics administered. The fluid choice should be based on analysis of electrolyte and acid–base status however lactated ringers solution has been shown to be more efficient than 0.9% NaCl for correction of metabolic derangements in experimental urethral obstruction. 36a If initial attempts to pass a urethral catheter into the bladder are unsuccessful in animals with urethral calculi or plugs, urohydropropulsion should be attempted. The success of urohydropropulsion can be improved by using urethral catheters of various sizes, lubricating agents, and topical and general anesthesia. Diagnostic and treatment plans can be formulated after a urethral catheter is passed into the bladder. If a urethral catheter cannot be passed, bladder decompression can be maintained by intermittent cystocentesis or insertion of a cystostomy tube (placed under local block and sedation) until the patient is sufficiently stable to perform definitive surgery. 25,107 The bladder should be drained to the maximum extent possible to reduce the risk of leakage through the puncture site. A sample of urine should be obtained by cystocentesis or urethral catheterization before administration of antibiotics.
Positive-contrast retrograde urethrocystography is the imaging modality of choice for evaluation of urethral lesions. 92 Negative-(air) contrast radiography is contraindicated with suspected lower urinary tract trauma because instillation of air into the injured bladder can result in fatal air embolus 1,113 additionally, use of negative-contrast agents rarely demonstrates the location of urethral injury. For positive-contrast studies of the urethra, a balloon-tipped catheter is placed in the distal urethra of males or the distal urethra or vagina (retrograde vaginourethrocystography) of females. Aqueous sterile iodinated contrast material is infused, and the urethra is distended. External compression of tissues around the entry point of the catheter may be required to prevent leakage of contrast material. Ideally, continuous imaging using fluoroscopy should be performed during contrast injection. Orthogonal and oblique radiographic projections can be of value to avoid superimposition of the urethra with skeletal structures. Signs of urethral disease include filling defects and contrast medium extravasation (Figure 117-5). 92
Ultrasonographic examination is limited to the extrapelvic urethra but can add complementary information about urethral wall thickness and mucosal surface contour. 50 Computed tomographic and magnetic resonance imaging of the normal canine urethra have been described in normal animals however, the utility of these imaging modalities in animals with urethral disorders has yet to be demonstrated. 111,120
Recent advances in equipment and training have resulted in an increased use of cystoscopy and urethroscopy for evaluation and treatment of a variety of lower urinary tract diseases. 79 Urethroscopy allows direct observation and biopsy of areas of interest and provides opportunities for intervention (Figure 117-6). Advanced techniques include transurethral cystoscopic dilatation of urethral strictures, mass or polyp resection, laser lithotripsy, submucosal collagen injections, and laser ablation of ectopic ureters or polyps.*
The urethra possesses impressive healing capacity under optimal conditions, urethral mucosa can regenerate within 7 days. 14 Critical factors that influence urethral healing are mucosal continuity and urine extravasation. 13 Urethral tissue becomes markedly edematous with manipulation and increasing duration of surgery, obscuring identification of tissue layers that may result in suboptimal suture placement and poor tissue apposition. 13 Use of magnification loupes may improve identification of the urethral mucosa. Achieving uncomplicated healing with minimal fibrosis is essential to minimize the occurrence and severity of urethral strictures. Narrowing of the urethral diameter must reportedly exceed 60% before an animal shows clinical signs 69 nonetheless, urethral stricture formation is a recognized potential sequela to urethral trauma and surgery.
Conservative therapy is indicated for minor urethral injuries, such as contusions, small lacerations, and perforations that result from catheterization. 23 Large urethral defects will heal spontaneously by second intention provided that a strip of urethral mucosa remains intact across the damaged tissue and the flow of urine is diverted. 121 It is often possible to pass a urethral catheter in a retrograde direction in the presence of a urethral laceration postcatheterization positive-contrast radiography is recommended to confirm that the catheter has not been passed through a defect in the urethra.
The decision as to whether or not to leave a urethral catheter in place after surgery is, to some degree, a matter of surgeon preference. Repeated exposure of submucosal tissue to urine may promote formation of scar tissue, reducing the elastic qualities of the affected region of urethra. 90 Although preventing contact of the wound with urine may decrease inflammation, the presence of the catheter can promote inflammation. 69 Some reduction in urethral luminal diameter at the site of surgical repair is anticipated, regardless of whether or not a catheter is left in place after surgery.
The ideal suture material should maintain tensile strength and tissue apposition until wound repair is satisfactory and should then undergo rapid total absorption at a dependable rate. In general, the lower urinary tract is expected to heal rapidly. In experimental dog models, suture in healthy bladder tissue was covered by epithelium within 5 days. 51 Although urethral healing was not described in that study, it is assumed to heal in a similar manner. Inflamed, infected, or damaged urothelium may not reepithelialize as quickly, and exposure of suture materials to urine, especially in the presence of infection or altered pH, may accelerate the loss of tensile strength through increased hydrolysis. 105
A variety of suture materials are available and are effective for urethral surgery. In general, most synthetic absorbable sutures retain adequate strength for urethral repair. Monofilament synthetic absorbable suture material, typically either 4-0 or 5-0 USP sizes, with a swaged-on needle, is appropriate in small animals. 59 Polydioxanone (PDSII Ethicon), polyglyconate (Maxon Syneture), poliglecaprone 25 (Monocryl Ethicon), and glycomer 631 (Biosyn Syneture) are all acceptable suture materials. Experimentally, however, the tensile strength of poliglecaprone 25 is lost at a relatively rapid rate in the presence of urine. 45 This suture may be inappropriate if delayed healing is anticipated, although clinical trials are lacking. Use of braided multifilament suture materials such as polyglactin 910 (Vicryl Ethicon) has been questioned because it may harbor bacteria and undergo rapid degradation in urine 105 however, anecdotal evidence supports its successful use in urethral tissue.
As mentioned previously, postoperative urethral catheterization is somewhat controversial. Although exposure of traumatized urethral tissue to urine may result in delayed healing and increased periurethral fibrosis, urethral catheters initiate a certain amount of inflammation and can promote ascending infection. 70,71,83 Diversion of urine can be provided by transurethral catheterization or placement of a cystostomy catheter. At least one study suggests that based on radiographic, dynamic, and histologic evaluation, the type of urinary diversion used does not influence urethral function or healing. 30 Urinary diversion into the gastrointestinal tract has been described in dogs but is associated with a prohibitively high complication rate. 110
The decision as to whether or not to suture the urethrotomy site is based on surgeon preference. Although primary and second intention healing of urethrotomy sites are similar, more hemorrhage has been observed when the urethrotomy is not sutured. 118,122 Suturing is performed with 4-0 or 5-0 monofilament absorbable material in an interrupted or continuous pattern. Generous application of petroleum-based jelly around the urethrotomy (but not in the wound itself) may reduce urine scalding and scrotal dermatitis that can occur when urethrotomy sites are left open.
five to eight times the urethral diameter) with fine scissors to ensure adequate size of the stoma. The incision may initially appear excessive however, the stoma will reduce to one half to two thirds its initial length after healing is complete. 107 The urethra often bleeds profusely from the incision, but bleeding decreases as sutures are placed.
The urethra is sutured to the skin using 4-0 or 5-0 monofilament suture material in a single-layer simple interrupted or simple continuous pattern. The use of absorbable monofilament sutures (e.g., poliglecaprone 25 or glycomer 631) has been described, 107 but the authors have a strong preference for the use of monofilament nonabsorbable sutures because of the inconsistent rate of absorption and loss of absorbable suture placed in this location. The suture is passed through the mucosa and fibrous tissue of the urethral wall but includes only dermis and epidermis of the skin. This facilitates precise approximation of the skin to the wall of the urethra. On completion of the scrotal urethrostomy, it should be possible to advance a catheter from the urethrostomy site into the perineal urethra and bladder. An Elizabethan collar or other restrictive device is placed on the dog before recovery. Nonabsorbable sutures are removed 10 to 14 days after placement, and sedation may be required for suture removal. Absorbable sutures are usually sloughed by the patient within 1 to 2 weeks after Elizabethan collar removal.
The most common complication of scrotal urethrostomy is persistent hemorrhage. Reportedly, use of a simple continuous pattern for urethrocutaneous apposition reduces the average duration of active bleeding from 4.2 days to 0.2 days. 20,85 In the authors’ experience, there is no advantage associated with use of a continuous pattern for closure of urethrostomy provided sutures are placed appropriately. Bleeding associated with urination is detected for an average of 3 to 5 days after urethrostomy and usually is self-limiting. Hemorrhage that persists for more than 10 to 14 days after surgery may necessitate revision of the urethrostomy site. Intermittent urine scald, recurrent urinary tract infections, and recurrent obstruction from struvite calculi were each noted in 20% of dogs after scrotal urethrostomy in one report. 85 Stricture is rare and is likely a result of a previous insult (e.g., calculus), poor surgical technique, or postoperative self-trauma.
Perineal urethrostomy for treatment of distal urethral obstruction and injury was first reported in 1963. 27 Various techniques and modifications have been described for urethrostomy in male cats, 60,99 but the Wilson and Harrison technique is most commonly used 22,126 and is described in this text. The penis is freed of its pelvic attachments, the urethra is transected cranial to the penile portion, and the pelvic urethra is sutured to the perineal skin. 126 A modification of the perineal urethrostomy entailing anastomosis of the urethra to a remnant of the preputial mucosa has been described in a series of male cats. 128 The authors suggested that this procedure improves cosmesis and decreases the incidence of postoperative stricture and bacterial cystitis. More experience with the technique is required to assess these claims, however, and this modification has not been widely adopted to date.
The prepubic urethrostomy is a salvage procedure used mainly in cats after urethral trauma/stricture or failed perineal urethrostomy ( Fig. 38-15 ). In the prepubic urethrostomy ( Box 38-3 ) the urethra is exposed through the abdominal wall cranial to the pubis. It is important to ensure that the urethra is not kinked or twisted during the surgery and to maintain as much urethral length as possible to avoid incontinence.
The improved continence seen when longer lengths of urethra are retained has led to the subpubic/transpubic modification of the prepubic urethrostomy, where the urethral stoma is positioned at the level of the postprostatic pelvic urethra, either by removing a section of the ischial bone or performing a pubic osteotomy.
Results after prepubic urethrostomy are unpredictable with a number of complications seen, including urinary incontinence, subcutaneous leakage of urine, stricture of the urethrostomy, recurrent UTIs, and urine-scald dermatitis. In two case series of 32 and 16 cats that underwent prepubic urethrostomy, around one-third underwent euthanasia due to urinary incontinence or stomal complications 49,50 and owner satisfaction in the remaining cats was not high.