Page 217 - Manual of Equine Field Surgery
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Perinea! Urethrotomy in Males 213
EXPECTED OUTCOME Urethrostomy for permanent urine diversion is
created by a two-layer closure over the above
described urethrotomy (see Figure 38-3 B). Ini-
Cystic urolithiasis carries a favorable prognosis,
but owners should be forewarned about the pos- tially, a hemostatic layer is performed by suturing
sibility of recurrence.t" Urethral urolithiasis can the bulbospongiosus muscles and the corpus spo11-
giosum penis, using No. 3-0 synthetic absorbable
be treated successfully if diagnosis and treatment suture, in a simple continuous pattern. The
are performed early, tl1us avoiding urethral second layer is performed in a simple interrupted
obstruction and bladder rupture. The success of pattern, using No. 2-0 polypropylene, connecting
urethrotomy for treatment of other urinary
obstructive lesions depends primarily on the the urethral mucosa to the perineal skin. Meticu-
lous, tensionless apposition of the mucosa to the
nature and extent of the lesion.
skin is crucial to prevent dehiscence and lateral
urine diversion causing scald formation.1•2
COMPLICATIONS Laparocystotomy is an effective method for
cystic calculi removal. The primary disadvantage
Excessive bleeding in the form of a continuous is the need for general anesthesia. The primary
stream of blood warrants intervention. Applica- advantages are reduced trauma to the bladder and
tion of light pressure with gauze or cold packing urethra and decreased recurrence rate from com-
for 10 to 15 minutes is usually sufficient. However, plete calculi removal and the less traumatic nature
if significant bleeding persists, surgical explo- of the procedure. 5•9
ratio11 is indicated. If the corpus cavernosum Laparoscopy has also been used for cystic
penis is the source of bleeding, suturing the tunica calculi removal. The procedure necessitates
albuginea is indicated for prompt, effective hemo- general anesthesia, special equipment, and expe-
stasis. Urine scald is a coID1no11 sequel that can rience with the technique. However, it enables
generally be avoided by keeping the distal end of excellent visualization and access to the bladder. 11
the incision proximal to the ischial arch, Scald
should be cleansed, and affected areas should be COMMENTS
treated with silver-sulfadiazine cream, zinc-oxide,
or other nonirritating cream-ointment on a daily
basis. Unilateral urine scald caused by asymmet- As a treatment for urolithiasis, urethrotomy can
ric urine flow may be eliminated by applying be performed for retrieving small uroliths or
sutures at the contralateral side of the urethro- crushing larger ones using a lithotrite.' Most
tomy in an attempt to redirect the urine stream cystic calculi are large enough that they must be
straight caudally. Stricture formation can gener- crushed or broken i11to smaller pieces to allow
ally be prevented by careful attention to tech- removal through a urethrotomy incision. This can
nique, making 011e straight incision of adequate result in a long and somewhat traumatic proce-
length. Recurrence of urolithiasis may be dure. Other, less traumatic, options for eliminat-
more common following urethrotorny than with ing uroliths via urethrotomy include laser ( e.g.,
laparocystotomy due to incomplete fragment pulsed-dye) and electrohydraulic lithotripsy.t"
removal.9 Other reported complications include Performing the urethrotomy 24 to 48 hours before
rectal or urethral damage, orchitis, peritonitis, lithotripsy may provide for better visualization
incontinence, and bladder rupture. 9 with less hemorrhage. Following calculi fragmen-
tation, thorough bladder irrigation is indicated
and may be repeated postoperatively to decrease
ALTERNATIVE PROCEDURES recurrence and prevent cystitis.
Urethral rents can be treated by perinea} release REFERENCES
incision. The procedure is identical to that of per-
inea! urethrotorny but avoids entering the ure-
thral lumen. The incision through the corpus 1. van Harreveld PD, Gaughan EM, Lillich JD:
Urethral surgery in horses, Comp Cont Educ Pract
spongiosum penis presumably provides a tern- Vet 20:739, 1998.
porary alternative route for the blood, while 2. Lillich JD, DeBowes RM: 'Urethra. In Auer JA, Stick
allowing the urethral rent to heal by second JA, editors: Equine surgery, ed 2, Philadelphia, 1999,
intention, 3' 10 WB Saunders.
