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1.
Eleven cats required urethral stoma revision because of urethral stricture following perineal urethrostomy. At surgery, eight cats had evidence of inadequate dissection to the bulbourethral glands, and three cats had evidence of urine extravasation into the subcutaneous tissues. Following revision of the stoma, long-term follow-up was obtained in nine cases. For eight cats, owners reported no complications after the revision. Failure to dissect beyond the bulbourethral glands and inadequate mucosa-to-skin apposition resulted in postoperative stricture formation. Stoma revisions were performed a median of 71 days following the initial perineal urethrostomy, indicating that long-term evaluation of cases is necessary.  相似文献   

2.
It has been reported that perineal urethrostomy resulted in impairment of striated-muscle urethral sphincter function in male cats, as measured by urethral pressure profilometry and electromyography (EMG). Our study was undertaken to describe and evaluate a surgical technique for perineal urethrostomy that reduces trauma to the urethral branches of the pudendal nerve. Perineal urethrostomy was performed on 10 healthy neutered cats after demonstrating that they had normal urethral sphincter function by urethral pressure profilometry (maximal urethral closure pressure [MUCP] = 151 +/- 52 cm of water) and EMG activity at the level of the striated-muscle sphincter before surgery. All cats had normal urethral sphincter function 1 week (MUCP = 194 +/- 19 cm of water, EMG activity present) and 3 weeks (MUCP greater than 200 cm of water, EMG activity present) after surgery. These results indicated that preservation of the urethral branches of the pudendal nerve during urethrostomy preserved striated-muscle urethral sphincter function.  相似文献   

3.
Objective-To describe the technique and determine outcome for male cats with urethral obstruction treated with fluoroscopically guided percutaneous antegrade urethral catheterization (PAUC). Design-Retrospective case series. Animals-9 client-owned neutered male cats with urethral obstruction and inability to pass a retrograde urinary catheter. Procedures-Information regarding the procedure and hospitalization was obtained from medical records. Long-term follow-up was obtained via medical record review or telephone interview. Results-Diagnoses included iatrogenic urethral tear (n = 6), obstructive urethral calculi (1), urethral ulceration (1), and urethral stricture (1). Seven of the 9 procedures were successful. The 2 patients in which PAUC failed had mechanical obstructions preventing guide wire access across the urethral obstruction. Procedure times ranged from 25 to 120 minutes. No complications were noted in any patients during the procedure. One patient was euthanized because of unrelated disease. Follow-up information was available for 6 of 8 surviving patients. No complications that could be directly attributed to the procedure were noted. All 6 patients had a perineal urethrostomy performed 0 days to 6 weeks following the procedure because of reobstruction of the lower urinary tract. None of these patients had documented urethral strictures and none had recurrence of clinical signs following perineal urethrostomy. Conclusions and Clinical Relevance-Results suggested that PAUC can be a simple, rapid, minimally invasive, and safe technique to facilitate transurethral catheterization in select cases. Patients with iatrogenic urethral tears may be good candidates. Patients with impacted urethral calculi, severe strictures or ulcerations, or a nondistended urinary bladder may be less amenable to PAUC.  相似文献   

4.
It has been reported that the prevalence of bacterial urinary tract infection (UTI) increases after perineal urethrostomy in male cats. Perineal urethrostomy, using a surgical technique preserving striated urethral sphincter function, was performed on 2 groups of cats. The first group consisted of healthy castrated cats. The second group of cats had recurrent or persistent urethral obstruction. All cats had normal urethral sphincter function after surgery, as measured by urethral pressure profilometry and electromyography. Long-term periodic urinalysis and bacterial culturing of urine was performed on all cats. Twenty-two percent of the previously obstructed cats had recurrent bacterial UTI, compared with none of the healthy cats. On the basis of these findings, we suggest that perineal urethrostomy per se does not predispose cats to bacterial UTI, but surgical alteration of the urethral meatus combined with an underlying uropathy may increase the prevalence of ascending bacterial UTI after surgery.  相似文献   

5.
Urethral injuries are relatively common in male dogs and cats. Urethral epithelium has impressive regenerative properties, and healing by second intention is effective as long as there is mucosal continuity across the traumatized area. Principles of managing traumatic urethral injuries include an accurate patient assessment, including a determination of the extent of the urethral injury; correction of electrolyte or acid-base disturbances; provision of urinary diversion, particularly with pelvic or perineal urethral defects; drainage of extravasated urine; and selection of a surgical procedure to repair or bypass the injured portion of urethra. Treatment options include temporary urinary diversion through cystostomy or urethral catheterization and second intention healing, permanent bypassing of the traumatized area through urethrostomy proximal to the injury site, and primary repair of transection injuries. The scrotal site is the most frequently used and preferred site for urethrostomy in the male dog to bypass the injured penile urethra. Urethral surgery necessitates care and attentiveness to detail, considering that accurate approximation of urethral mucosa minimizes fibrosis and helps maintain an adequate luminal diameter. Avoidance of stricture and preservation of function are goals of managing traumatic urethral injuries.  相似文献   

6.
OBJECTIVES: To evaluate indications for and outcome of perineal urethrostomy in cats. METHODS: The medical records of 59 cats that had undergone perineal urethrostomy were evaluated. Short-term follow up information (for a period of four weeks following surgery) was available for all of the cats. Long-term follow up information (for a period of at least four months) was available for 39 cats. RESULTS: Early complications occurred in 25.4 per cent of cats and late complications were observed in 28.2 per cent of cats. The most frequent late complication was recurring bacterial urinary tract Infection. CLINICAL SIGNIFICANCE: Despite frequent complications and recurring signs of lower urinary tract disease, 32.2 per cent of the cats had a disease-free long-term outcome (mean four years, median 3.9 years), and 88.6 per cent of clients interviewed thought that their cats had a good quality of life after surgery.  相似文献   

7.
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8.
OBJECTIVE: To investigate the indications for and long-term outcome of prepubic urethrostomy (PPU) in the cat. STUDY DESIGN: Retrospective survey. ANIMALS: Sixteen cats that had undergone PPU. METHODS: Data were recovered from the medical records of the cats. Follow-up information was obtained from the owners and referring veterinarians. RESULTS: Indications for PPU were: failed perineal urethrostomy for the management of idiopathic lower urinary tract disease (ILUTD) (8 cats) or urethral trauma (1 cat); unresolved pelvic urethral obstruction after recurrent ILUTD (5 cats); and stenosis of the pelvic urethra as a result of trauma (2 cats). A patent urethral stoma was created in all cases. Signs of lower urinary tract disease were present in 8 cats postoperatively. With appropriate dietary management, these signs resolved in 2 cats and improved in another 4 cats. Eleven cats experienced postoperative complications that consisted of peristomal skin irritation or necrosis (7 cats) and urinary incontinence (6 cats). Complications developed in the immediate postoperative period in 6 cats, and resolved in 2 of these. Six cats developed late complications, at 6 to 84 months postoperatively. Six cats were euthanatized between 1 and 26 months' postoperatively. The mean survival time in these cats was 13 months. Reasons for euthanasia included urinary incontinence (3 cats), skin necrosis (2 cats), and unresolvable ILUTD (1 cat). CONCLUSIONS: PPU is a salvage procedure that is successful in relieving the signs of urinary tract obstruction and preventing further obstruction. However, potential complications should limit its use to cases in which standard techniques for perineal urethrostomy cannot be performed. CLINICAL RELEVANCE: PPU is a comparatively simple procedure that should be considered as a salvage technique for obstructive disease of the pelvic urethra.  相似文献   

9.
The frequency and cause of recurrent lower urinary tract disease was compared prospectively in three groups of 10 male cats during a one year period following correction of obstructive urethropathy caused by matrix-crystalline plugs. One group of cats was managed by perineal urethrostomy, one group with a calculolytic diet, and the third group by perineal urethrostomy and the calculolytic diet. Ten episodes of bacterial urinary tract infection developed in five of 10 cats with perineal urethrostomies; six episodes of bacterial urinary tract infection developed in four of 10 cats with perineal urethrostomies and consuming the calculolytic diet. Bacterial urinary tract infections were not observed in cats managed only with the calculolytic diet. Staphylococcal-induced struvite urocystoliths developed in two cats with perineal urethrostomies. Vesicourachal diverticula detected in nine cats at the time of diagnosis of urethral obstruction healed spontaneously following restoration of urethral patency and remission of clinical signs. Transient microscopic haematuria was observed in approximately 25 per cent of the cats in all three treatment groups during the one year study. Results of this study confirm the effectiveness of dietary management in prevention of recurrent urethral obstruction caused by struvite-containing urethral precipitates, and verify that recurrent signs of lower urinary tract disease in cats may be caused by agents that are different from those that initiate the problem. They also confirm that perineal urethrostomies predispose cats to recurrent ascending bacterial urinary tract infections.  相似文献   

10.
A 4-yr-old, 300-kg male Bongo antelope presented a fluctuant swelling on the ventral abdomen surrounding the penis, which was confirmed later as compatible with urethral rupture. Initial treatment included broad-spectrum antibiotic and radical surgical debridement. Total prepuce and partial penile amputation with orchidectomy was performed and normal micturition was restored. At a later stage, when the extent of the lesion was controlled, a permanent scrotal urethrostomy was performed. Complete healing by second intention was achieved 2 mo after the last surgery. Although the outcome was very good, considering the extent and severity of the tissue damage, prompt permanent urethrostomy when urethral rupture was first suspected would have prevented deterioration of the condition and prevented the need for extensive surgery.  相似文献   

11.
OBJECTIVE: To determine hospital proportional morbidity rates (HPMR) for urethral obstructions, urethral plugs or urethroliths, and urethrostomies in cats in veterinary teaching hospitals (VTH) in Canada and the United States between 1980 and 1999. DESIGN: Epidemiologic study. ANIMALS: 305,672 cats evaluated at VTH. PROCEDURES: Yearly HPMR were determined for cats with urethral obstructions, urethral plugs or urethroliths, or urethrostomies from data compiled by the Purdue Veterinary Medical Database. The test for a linear trend in proportions was used. RESULTS: Urethral obstructions were reported in 4,683 cats. Yearly HPMR for urethral obstructions declined from 19 cases/1,000 feline evaluations in 1980 to 7 cases/1,000 feline evaluations in 1999. Urethral plugs or urethroliths affected 1,460 cats. Yearly HPMR for urethral plugs or urethroliths decreased from 10 cases/1,000 feline evaluations in 1980 to 2 cases/1,000 feline evaluations in 1999. A total of 2,359 urethrostomies were performed. Yearly HPMR for urethrostomies decreased from 13 cases/1,000 feline evaluations in 1980 to 4 cases/1,000 feline evaluations in 1999. CONCLUSIONS AND CLINICAL RELEVANCE: Frequency of feline urethrostomies performed at VTH in Canada and the United States declined during the past 20 years and paralleled a similar decline in frequency of urethral obstructions and urethral plugs or urethroliths. These trends coincide with widespread use of diets to minimize struvite crystalluria in cats, which is important because struvite has consistently been the predominant mineral in feline urethral plugs during this period.  相似文献   

12.
Perineal urethrostomy was performed in five male cats with minimal, sharp intrapelvic transection of the ischiocavernous and ischiourethralis muscles and ventral penile ligaments, and in five male cats with extensive blunt intrapelvic dissection and sharp muscle transection. Urethral pressure profiles and cystometrograms with simultaneous fine wire electrode sphincter electromyography were performed in sedated cats before surgery and on days 14 and 28. Premicturition pressure, urethral opening pressure, maximum detrusor pressure, total volume infused, and residual volume were measured during cystometry, and maximal urethral closure pressure was measured during profilometry. A grading of (+), (++), or ( ) was used to represent the intensity of electromyographic activity. There was no difference between minimal and extensive dissection for any cystometrogram or profile variable at days 14 or 28. Urethral opening pressure and maximal detrusor pressure during cystometrography were higher in preoperative studies than after minimal or extensive dissection. Sphincter electromyography after surgery was not significantly different from preoperative results in either surgical group. The results of this study indicate that neither sharp nor blunt intrapelvic dissection significantly alters the postoperative urodynamic status in male cats.  相似文献   

13.
A modified perineal urethrostomy was performed in 14 males cats with partial or complete urethral obstruction. Follow-up information was available for 2 to 18 months. By use of this method, the preputial tissues were preserved, and the penile urethra was anastomosed to the preputial mucosa to enlarge and lengthen the urethra. Urine flow was reestablished in all cats without evidence of urethral stenosis or other major complications. Appearance of the perineal region and prepuce was not substantially altered.  相似文献   

14.
Closure with a simple continuous pattern using absorbable suture was evaluated in 18 cats that underwent perineal urethrostomy from 2000 to 2002. The perineal urethrostomy was performed in a similar manner in all the cats, and either 4-0 or 5-0 polydioxanone was used for closure. Cats were evaluated 2 weeks postoperatively, and long-term follow-up information was reviewed. In all cats, the perineal urethrostomy site was healed within 2 weeks. None of the cats developed a stricture postoperatively. Complications were not significantly different (P>0.50) from those found in a comparison group of 21 cats operated between 1997 and 2002, in which perineal urethrostomies were performed using nonabsorbable sutures that were removed postoperatively.  相似文献   

15.
Evaluation of urethral pressure profilometry (UPP) with simultaneous fine-wire electromyography of the external urethral sphincter (EUS) was conducted in 11 healthy adult male cats sedated with xylazine and ketamine. A 3.5-F urethral catheter with a closed end and two 1-mm side-ports was infused with sterile 0.9% NaCl solution at a rate of 2 to 3 ml/min. A fine-wire electromyographic (EMG) electrode was placed percutaneously into or near the external urethral sphincter prior to the onset of the UPP. The maximal urethral pressure achieved and functional profile length were recorded from UPP. Setting both catheter withdrawal rate and paper speed at 5 mm/s enabled the measurement of actual urethral length directly from UPP. Sphincter EMG activity was rated as slight (+), moderate (+ +), or intense (+ + +). All recordings were replicated once during each trial for 8 cats and trials were replicated 5 to 7 days later in 4 cats. Before catheterization, EMG activity of the external urethral sphincter was rated slight (+), whereas intense (+ + +) activity accompanied insertion. The activity evoked by movement of the catheter subsided, but intense EMG activity of the external urethral sphincter was recorded from onset to completion of catheter withdrawal in all cats in both trials. The mean maximal urethral pressure was 93.1 +/- 13.29 cm H2O. The mean function urethral length was 8.1 +/- 0.93 cm. Maximal urethral pressure or function profile length did not differ significantly between recordings within trials or between trials. Simultaneous recording of EMG activity and UPP of the external urethral sphincter was shown to be a simple, noninvasive technique for assessing neuromuscular and anatomic urethral function.  相似文献   

16.
The aim of this study was to evaluate the course of urethral obstruction in cats. Forty-five male cats with urethral obstruction or lower urinary tract signs referable to urethral obstruction were included in the study. Follow-up information was gained by telephone interview in most cases and was available in 39 cats. Of the 22 cats with idiopathic urethral obstruction, eight (36%) re-obstructed after 3-728 days (median 17 days). Of 10 cats with urolithiasis, three (30%) re-obstructed after 10, 13 and 472 days, respectively. Of the seven cats with urethral plugs, three (43%) re-obstructed after 4, 34 and 211 days, respectively. Recurrent signs of lower urinary tract disease including obstruction were common in cats with urethral obstruction (20/39; 51%) and occurred in the same frequency irrespective of the primary cause of the obstruction. Recurrent obstruction (14/39; 36%) was the most common reason for euthanasia and was performed in 8/39 (21%) cats.  相似文献   

17.
OBJECTIVE: To assess the management of traumatic urethral ruptures using a systematic attempt at urethral catheterisation. METHODS: Eleven cats that had been diagnosed with a traumatic urethral rupture over a five-year period were included in this study. Rupture was assessed by positive-contrast retrograde urethrography. An attempt was made to manage these ruptures by placing an indwelling urethral catheter. RESULTS: The placement of an indwelling urethral catheter, could be performed in 10 out of 11 cats, which indicated a partial rupture. In one cat, catheterisation was not possible because of complete urethral rupture. A urethral catheter was placed into the urinary bladder via the urethra in five animals. In the other five animals, urethral catheterization required cystotomy using a modified 'inside to outside' technique. Urethral catheter removal occurred between five and 14 days after placement. Urethral healing was accomplished in all cases of catheterisation with a good outcome in eight of the 10 cats. Two cats showed clinical signs related to stricture formation during the follow-up period (seven to 72 months). Retrograde urethrography provided a definitive diagnosis of partial rupture in only six of the 10 cases of partial rupture. CLINICAL SIGNIFICANCE: Results suggested that primary alignment with the placement of a urethral catheter should be attempted for the management of traumatic urethral ruptures in cats. Gentle urethral catheterisation seems to be an effective procedure for diagnosing and dealing with partial urethral rupture in cats. Clinical stricture formation can occur, but the risk does not seem to be high. Further studies are warranted in order to define the ideal duration for maintenance of an indwelling urethral catheter in cases of traumatic partial urethral rupture.  相似文献   

18.
Urethral pressure and electromyographic evaluations were performed in 10 healthy, intact female cats and in 10 healthy, ovariohysterectomized (OVH) female cats. Mean maximum urethral closure pressure was 71.4 +/- 25 cm of water for intact cats and 77.5 +/- 31.3 cm of water for OVH cats. Mean maximum pressure of the proximal 60% of the urethral pressure profile length was 39.2 +/- 7.4 cm of water for intact cats and 32.1 +/- 11.6 cm of water for OVH cats. Mean maximum pressure of the distal 40% of the urethral pressure profile length was 76.2 +/- 27.4 cm of water in intact cats and 80.5 +/- 32.9 cm of water in OVH cats. Significant differences between intact and OVH cats were not found in mean maximum urethral closure pressure, proximal urethral sphincter pressure, or distal urethral sphincter pressure.  相似文献   

19.
Objective: To evaluate selected historical and physical parameters as predictors of hyperkalemia in male cats with urethral obstruction. Design: Retrospective study. Setting: Veterinary teaching hospital. Animals: Two hundred and twenty‐three male cats. Interventions: None. Measurements and main results: The metabolic derangements of 223 male cats that presented with urethral obstruction from 1997 through 1999 were reported in a companion article. Approximately 12% of the cats had multiple, life‐threatening metabolic derangements. In the present study, historical and physical parameters were evaluated as predictors of hyperkalemia (K+≥8.0 mmol/L) in cats with urethral obstruction. The 4 historical parameters significantly associated with hyperkalemia were: first time obstruction, outdoor status, anorexia, or vomiting. The 5 physical parameters significantly associated with hyperkalemia were: rectal temperature, heart rate, respiratory rate, pulse quality, and the presence of arrhythmia. Of the physical parameters, a rectal temperature below 95–96.6°F (35–35.9°C) or a heart rate below 120 b.p.m. were the most accurate predictors. When used in combination (i.e., evidence of bradycardia and hypothermia), the specificity for hyperkalemia was 98–100%. Conclusions: Rectal temperature and heart rate were the best parameters for predicting hyperkalemia in this population.  相似文献   

20.
A urethral defect, presumed to communicate with the corpus spongiosum penis, caused hematuria in seven geldings and hemospermia in three stallions. Hematuria in geldings occurred at the end of urination. Hematuria was not observed in stallions with hemospermia. A linear urethral defect was identified, by endoscopic examination, on the convex surface the urethra at the level of the ischial arch of each horse. Cause of the defect was not determined. Two stallions were successfully treated for hemospermia, one by temporary subischial urethrostomy combined with sexual rest for 10 weeks, and the other by sexual rest alone for 6 months. The third stallion had hemospermia 6 weeks after urethrostomy. The geldings were successfully treated for hematuria, six by temporary subischial urethrostomy, and one by a subischial incision that extended into the corpus spongiosum penis but did not enter the lumen of the urethra. Efficacy of subischial urethrostomy for treatment of hemospermia was difficult to assess because of the small number of surgically treated stallions. In geldings, surgery eliminated hematuria, presumably by reducing vascular pressure in the corpus spongiosum penis during urination, thus allowing the urethral defect to heal.  相似文献   

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