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Date:   02 February, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

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CYSTOSTOMY AND/OR URETHROSTOMY IN UROLITHIASIS   
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written:  02 February, 2010

 
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Be Kind To Pets
Veterinary Education
Project 2010-0129
URETHROSTOMY METHOD
The surgical approach to removing the urinary stones in the dog or cat depends on the vet. If the urinary stones are stuck at the urethra behind the os penis, the logical approach will be to cut open the urethra behind the penile bone and remove the stones. The male dog should then pee like a female dog. He squats down and pees. In practice, an old male dog may not be able to change his mindset. He has had been peeing with one leg up, against a vertical surface or he may have been urine-marking all the time. Now, a human being expects him to pee like a female dog. This is expecting too much even in people who have had to change their mindsets.   

What if the male dog with urethrostomy continues his old way? He may have a sad ending as I recall the following case. A Chihuahua whose owner resided in Toa Payoh in 2004 could not pass urine. The urinary stones blocked his urethra at the os penis (penile bone). His bladder was going to rupture soon. I advised
surgery to create an opening behind the os penis so that he would be able to pass urine and to survive. This surgery is called urethrostomy.

The owner went to another vet  after getting a diagnosis from me. Such situations happen to all vets and so I was not offended.

The other vet did a urethrostomy behind the os penis as this is a standard practice. There were no stones in the bladder I presumed as the owner did not want me to handle the case. The problem of being unable to pee was resolved. However, the owner brought the dog to me some weeks later and said: "My Chihuahua pees like a female dog. He dribbles urine all over the apartment after the surgery (see photo above). I want him to be put to sleep." 

Vets do urethrostomy if the bladder has no stones and stones are found only in the urethra. It is logical. But should the dog continues urine-marking, the urine just "leaks" everywhere as I suspected in the above-mentioned Chihuahua. In theory, male dogs with urethrostomy should be able to control their urination and pee at approved places. The theory is fine if you are not the Chihuahua or the owner needing to clean up the apartment hundreds of times a day.

In retrospect, it is best to properly house-train your puppy or neuter him when he is young to prevent urine-marking. Urine-marking affects the cleanliness of the apartment and other family members may not be too pleased about this anti-social behaviour.   

If there are no stones inside the bladder, most vets will use the urethrostomy method. It is logical. However, in the above case, a cystostomy would have enabled this male Chihuahua to live to the end of his life-span. But how many vets would do a cystostomy when stones are present behind the os penis? I doubt there are any. However, a cystostomy to remove all stones may be best for the male dog living inside an apartment.

A cystostomy case with urohydropropulsion is shared with fellow vets below.

CYSTOSTOMY METHOD
Yorkshire Terrier, Male, 9 years. 3.6 kg 39.4C
Urethral obstruction. X-rays showed urinary stones in the bladder and behind the os penis. What is the surgical approach?


 

30.1.2010

31.1.2010

Domitor 0.3ml IV
Isoflurane gas
Antisedan 0.3 ml IM at the end of surgery

IV glucose 200 ml pre-surgery
Hartman Solution IV 2 days post op
Baytril 0.3 ml and Rimadyl 0.2 ml SC
Ate l can A/D diet. T=38.7 deg C
To flush bladder again. Lots of bleeding and debris.

Catheter in the bladder for at least 3 days. Nursing needed.

 

 

SURGERY on 30.1.2010
In this case, cystostomy was performed, although some vets do cystostomy and urethrostomy as dictated by the presence of numerous stones in the penile urethra.

A catheter is used to dislodge all stones via flushing many times during the operation. The catheter was inserted via the penile urethra and the bladder to dislodge and flushed all stones.

There was no need for urethrostomy although on first impression from the X-ray, a urethrostomy behind the os penis would seem logical. The dog was catherised for 3 days. I presume most vets would perform urethrostomy and cystostomy but it is best for the dog just to do cystotomy with urohydropropulsion.
 

 

 Cystotomy and urohydropropulsion resolved the dog's difficulty in urination problems for the time being  

4th Year Vet Students Studying Vet Surgery: For more information about the techniques of urohydropropulsion, see one of the cases at: Urinary Tract Problems

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Be Kind To Pets
Veterinary Education
Project 2010-0129
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