feline perineal urethrostomy - isvma

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Feline Perineal Urethrostomy

Steve Dullard DVM, DABVP (Canine and Feline Practice)

Advantages

� No knots at surgery site and away from

mucosa. Minimal irritation to site from licking.

� Allows rapid healing

� Use absorbable suture- I prefer 4-0 vicryl

because it is soft and if you are unable to remove all the suture at time of removal, it

will be reabsorbed and broken down.

Patient Preparation

� Patient is placed in ventral recumbency

� Purse string suture is placed in anus

� Padding placed under hips and in front of thighs

� Tie tail over back

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First incision

� An elliptical skin incision is made

around the penis and scrotum.

� The dorsal end of the incision is just ventral to the anus.

� Notice lack of bleeding with laser.

Dissecting the penis

� The penis is dissected away from the surrounding connective tissue.

� Leaving the catheter in place helps to visualize the penis.

� Use the penile sheath to manipulate the penis.

Dissecting the penis

� Remove the sheath until the penis is

completely exposed.

� Cleanup any fat and

connective tissue located on the penis.

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Dissecting to the ischium� Perineal fat is

removed until bulbourethral glands are exposed (intact cats).

� Retractor penis muscle is blue pointer.

� Ischiocavernosus and ischiourethralis muscles attached to ischium at green pointer.

Dissect muscle from ischium

� Free ischiocavernosus muscle from ischium.

� Cut muscle at muscle –bone interface to

minimize bleeding and to avoid branches of the pudendal nerves.

� Cut left and right sides until penis if free.

Dissect retractor penis muscle

� Dissect retractor penis muscle from

dorsal surface of penis.

� Amputate muscle at the most dorsal attachment.

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After penile retractor muscle removal

� Note the slightly purple color of the

urethra.

Incise the urethra longitudinally

� Using tenotomy scissors, start at the urethral opening and cut longitudinally up the urethra.

� Pay attention to staying on center.

� Cut to level of bulbourethral glands where the urethra widens.

Checking width of the urethra

� Gently use a mosquito forecep to

evaluate the width of the urethra.

� It should pass to the approximate level of the forecep hinge.

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Suturing the urethra

� I prefer a technique that minimizes knots at the urethrostomysite.

� Cats lick at it less and there is less inflammation at the skin-urethra interface.

� Use 4-0 monofilament nylon or vicryl / PDS with small cutting needle.


� Place a suture 1.5 cm lateral to your incision at the level of the ventral edge of your urethrostomy site.

� Tie it and without cutting the suture pass it under the skin to the incision edge.

� Suture coming out of the incision site and

fixed to skin 1.5 cm laterally.


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� Begin a simple continuous suture along the right side of the urethra.

� Take a bite of the urethral mucosa and then the skin so that the mucosa lies slightly over the skin when you appose the tissues.




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� After you have sutured all the way to the opposite side, place a suture under the skin and exit it 1.5 cm laterally.

� Transfix the suture.

� Place simple continuous sutures to appose the rest of the incision.

The blockage is resolved!

� The new orfice allows large amounts of crystal to be expressed from the bladder.

� Periodic urinalysis should be performed.

� Don’t forget to remove your purse string suture.

feline perineal urethrostomy - isvma

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