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SURGERY
six months of surgery, and mean survival was only 13
months.
• Subpubic urethrostomy.
A simple extension of the antepubic urethrostomy
technique involves preserving the pelvic urethra and
then transposing it to a subpubic position. 4 This tech-
nique avoids the urine scald associated with prepubic
urethrostomy in cats by placing the stoma caudal to
the abdominal fat pad. Preservation of more urethral
length may also contribute to improved continence
with this technique and improved resistance to urinary
tract infection, although no large studies have been
published to date.
• Primary revision.
A 2006 study described the results of primary revision
of the perineal urethrostomy by revised dissection and
mucosa to skin apposition.5 In this study, eight of 11
cats had inadequate dissection to the level of the bul-
bourethral glands and three had poor apposition of
skin to mucosa during initial surgery. Primary revision
of the stoma was effective in eight of nine cats availa-
ble for long-term follow-up.
Transpelvic urethrostomy. Another recent study de-
scribed transpelvic urethrostomy as an alternative
salvage procedure for cats with distal urethral trauma
or failed perineal urethrostomy surgery. 6 The caudal
aspect of the ischium is removed through a ventral
approach, and the urethral stoma is translocated to a
subpubic position. The advantage of this technique is
that it avoids the high rate of incontinence and urine
scalding that is seen in prepubic urethrostomy by pre-
serving the intrapelvic urethra and urethral sphincter.
Only one cat developed temporary incontinence,
which resolved by four weeks after surgery.
• Conservative therapy.
As many clinicians have learned, conservative therapy
with urethral catheterization or urinary diversion can
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provide an acceptable long-term solution in selected
animals with urethral tears and urine leakage. A recent
clinical retrospective study evaluated prognostic fac-
tors for animals with urethral trauma in 20 dogs and
29 cats. 7 Urethral rupture was more common in males
of both species, with aetiology being most common-
ly related to vehicular trauma in dogs and iatrogenic
injury during catheterisation in cats. The presence of
multiple traumatic injuries served as the only negative
prognostic indicator in this series, with location of
rupture, clinicopathologic findings, treatment method
(surgery versus catheterization) and etiology having
no significant effect on outcome.
• Tube cystostomy.
Tube cystostomy is an accepted method for short- or
long-term urinary diversion. A landmark study per-
formed in an experimental model of intrapelvic ure-
thral transection and primary repair in normal dogs
showed that there was no difference in healing of ure-
thral wounds when tube cystostomy was compared to
transurethral catheters or both techniques combined. 8
A recent follow-up study on tube cystostomy in 76
animals showed that complications were common
(49%), although most were treatable through nonsur-
gical intervention. 9 Urinary tract infection was near-
ly universal (16 of 17 animals that had urine culture
checked after tube implantation had positive) results.
Inadvertent tube removal was the most common ma-
jor complication (occurred in 12 of the 76 animals) but
was typically handled conservatively (n=8) or by tube
replacement (n=4). Only one animal required surgi-
cal revision due to uroperitoneum after tube removal.
The most common minor complication was irritation
around the tube site (n=7) or urine leakage around the
tube (n=7). Complication rate was not associated with
species, tube type or duration of tube retention.
References
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