Upper Urinary Tract Disease Associated with Urethral Stricture

Perineal urethrostomy (PU) is the surgical procedure performed in the male cat in order to create a permanent stoma of the pelvic urethra to the skin of the perineal region. The first urehrostomy was devised on early sixties and since then many urethrostomy techniques were invented. On 1971 Wilson and Harrison invented a technique of PU that is currently used by the majority of surgeons, because of the better results and fewer complications compared to the other urethrostomy techniques. Indications for performing PU in the male cat include recurrent urethral obstruction associated with lower urinary tract disease, as an emergency procedure for the restoration of the patency of the obstructed urethra when all other conservative measures failed, priapism, strictures, trauma and urethral neoplasms. For a successful PU: 1) the pelvic urethra should be incised and anastomosed in the perineum cranial to the bulbourethral glands, 2) the urethra should be completely freed from its attachments to the ishium so as to decrease tension to the stoma, and 3) accurate apposition of the urethra to the skin should be performed to achieve first intention healing of the stoma site and avoid stricture formation. Complications following PU may include urethral stricture, ascending urinary tract infection, haemorrhage, subcutaneous urine extravasation resulting in sloughing and dehiscence of the stoma, skin fold dermatitis, urinary and fecal incontinence, bladder atony, iatrogenic perineal hernia and rectourethral fistula. Prepubic, subpubic or transpelvic urethrostomy may be used to salvage postoperative urethral stricture. Pepubic urethrostomy is the only salvage technique that has been evaluated long-term, but is associated with serious complications such as urine scalding, urinary incontinence and urinary tract infection. Perineal urethrostomy aims at relieving urethral obstruction and is part of the medical management of cats with recurrent or persistent urethral plug formation.

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Application of Flexible Ureteroscope in Diagnosis and Treatment of Upper Urinary Tract Disease

Proceedings of the 2016 International Conference on Biomedical and Biological Engineering ◽

10.2991/bbe-16.2016.8 ◽

2016 ◽

Author(s):

Fanping Meng ◽

Jiantao Xian ◽

Xu Zhou ◽

Ji Gao

Keyword(s):

Urinary Tract ◽

Upper Urinary Tract ◽

Diagnosis And Treatment ◽

Flexible Ureteroscope ◽

Tract Disease

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CLINICAL APPLICATION OF PATLAK PLOT CT-GFR IN ANIMALS WITH UPPER URINARY TRACT DISEASE

Veterinary Radiology & Ultrasound ◽

10.1111/j.1740-8261.2010.01670.x ◽

2010 ◽

Vol 51 (4) ◽

pp. 421-427 ◽

Cited By ~ 18

Author(s):

KATE ALEXANDER ◽

MARILYN DUNN ◽

ERIC NORMAN CARMEL ◽

JEAN-PIERRE LAVOIE ◽

JÉRÔME R. E. DEL CASTILLO

Keyword(s):

Urinary Tract ◽

Clinical Application ◽

Upper Urinary Tract ◽

Patlak Plot ◽

Tract Disease

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Obstructive Urolithiasis in Horse

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.95451 ◽

2019 ◽

Vol 47 ◽

Author(s):

Marília Alves Ferreira ◽

Pedro Henrique Salles Britto ◽

Roberto Romano Do Prado Filho ◽

Guilherme Silva De Godoi ◽

Gabriela Alboléa Santo André ◽

...

Keyword(s):

Crystal Growth ◽

Urinary Tract ◽

Calcium Carbonate ◽

Tissue Injury ◽

Clinical Signs ◽

Upper Urinary Tract ◽

Invasive Technique ◽

Anatomical Location ◽

Perineal Ultrasonography ◽

Tract Disease

Background: Obstructive urinary tract disease in horses is a rare and low prevalence pathology in the species, but potentially severe. It is an emergency condition that presents variable clinical signs and depends on the anatomical location of the obstruction. The bladder calculus are the most common followed by the urethra and less commonly seen are the kidney or ureteral. The main crystalloid component of uroliths in horses is calcium carbonate. The higher prevalence of urolithiasis in male horses is justified by some anatomical differences between genders. The urethra of males is narrower and longer than that of females. The tissue injury is the most important factor for the development of uroliths in horses. Desquamation of epithelial cells, presence of leukocyte and necrotic cell debris are relevant contributors to crystal growth. Urinary stasis favors nucleation by increasing the chance of contact between crystalloid material and urinary epithelium. Once crystal growth has begun, the urine alkalinity of the equines favors the crystallization and further deposition of other components, especially calcium carbonate. Typical clinical signs of urolithiasis include tenesmus, dysuria, strangury and polaquiuria. Hematuria is often present, mainly observed after exercise and at the end of urination. In addition signs of colic are quite frequent in the acute bladder and urethral urolithiasis due to bladder distension. Upper urinary tract surgery may be technically challenging due to limited structural exposure, especially in adult horses The prognosis for horses with urolithiasis depends on the location of the urolith and the degree of renal injury that occurred.Case: This report aims to describe a rare case of obstructive urolithiasis in a 8-year-old castrated male horse with 24 h evolution. The horse was expressing signs of abdominal pain and during the transretal examination through palpation, it was possible to notice great distension and turgidity of the bladder, in addition to a high pain sensitivity to the palpation of the kidneys. Was perform urethral catheterization, but it was unproductive. The diagnosis was made through perineal ultrasonography and treated surgically by perineal urethrotomy. The animal presented an excellent evolution after being discharged after 10 days of hospitalization and did not present any complication or recurrence of the disease after one year of the procedure.Discussion: Urolithiasis in horses has a prognosis dependent on the location of the urolith and the degree of renal damage. Cases of obstructive urolithiasis in horses are rare and require prompt and appropriate intervention. Therefore, a rapid and accurate diagnosis is directly related to the success of the treatment. In the present case, the animal had characteristic clinical signs of an acute abdomen. Transrectal palpation, for evaluation of the intestinal portions, was important to diagnose an excessively distended urinary vesicle with no intestinal changes. Transcutaneous ultrasonography of the perineum allowed visualization of the calculus, and then a case of perineal urolithiasis was diagnosed. The choice for perineal urethrotomy was performed because of the ease of palpation of the calculus through the skin below the anus and because it is a non-invasive technique. The urethra was sutured to guide the cicatricial process and the urethral catheter was maintained, reducing the risks of occlusion of the urethral lumen.

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