Page 2383 - Cote clinical veterinary advisor dogs and cats 4th

1178 Urethral Occluder Placement

Alternatives and Their SUGGESTED READING
Relative Merits O’Hearn AK, et al: Coccygeal epidural with local
VetBooks.ir zine, buprenorphine, and medetomidine with anesthetic for catheterization and pain management
• A pharmacologic approach using aceproma-
in the treatment of feline urethral obstruction. J
Vet Emerg Crit Care 21:50-52, 2011.
repeat decompressive cystocentesis has been
reported for alleviating idiopathic urethral
obstruction (p. 332). AUTHORS: Jody P. Lulich, DVM, PhD, DACVIM; Carl A.
Osborne, DVM, PhD, DACVIM
• Urethrostomy may be indicated if obstruction EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
cannot be corrected. Contrast urethrography Thompson, DVM, DABVP
(p. 1181) is indicated to localize the site(s)
of obstruction and to select the location of
surgery.
Pearls
• Medical imaging of the urethra before
treatment (e.g., catheterization) is essential
to understand the cause and best approach
for patient care.
• Most cats are insufficiently anesthetized
to safely unobstruct the urethra. This is
URETHRAL OBSTRUCTION (FELINE): MEDICAL understandable because a deep plane of
MANAGEMENT Perineum of an anesthetized anesthesia may cause further cardiac and
cat undergoing medical management of urethral metabolic decompensation of the patient.
obstruction. Cat is in dorsal recumbency; cranial
is to right of the photograph. Occluding the distal Consider epidural anesthesia to sufficiently
urethra around the catheter and pulling the urethra anesthetize the perineal region to safely and
caudally and dorsally to displace urethral kinking more successfully clear the urethra.
facilitates retrograde flushing of plugs and stones
into the urinary bladder.

Urethral Occluder Placement Client Education
Sheet

Difficulty level: ♦♦♦ • Stainless steel reusable backfill catheter • A stay suture is placed in the apex of the
(Norfolk Vet Products) or syringe bladder and retracted cranially.
Synonym • Routine equipment needed for celiotomy • A 2-cm section of urethra is isolated using
Artificial urethral sphincter right-angle forceps at least 2 cm caudal to
Anticipated Time the bladder neck in the female dog and 1 cm
Overview and Goal Expected procedure time is 60-90 minutes caudal to the prostate in the male dog.
The artificial urethral sphincter (AUS) is indi- • Use a strand of suture or a Penrose drain to
cated for the treatment of refractory urinary Preparation: Important measure the urethral circumference.
incontinence secondary to urethral sphincter Checkpoints • The AUS should be roughly 50% of the
mechanism incompetence in dogs. • CBC, serum chemistry panel, urinalysis, and circumference (urethra = 20 mm and AUS
urine bacterial culture within 2 weeks of the = 10 mm).
Indications procedure • The AUS is primed with sterile saline to
• Urethral sphincter mechanism incom- • Abdominal radiographs flush out the air using a syringe or a backfill
petence (p. 1011) refractory to medical • Ensure appropriately sized AUS and vascular catheter. The fluid is then removed and the
management access port are available and sterile. tubing clamped.
• Pelvic bladder • The vascular access port is flushed with sterile
• Urethral hypoplasia Possible Complications and saline using a Huber point needle.
• Refractory incontinence following surgical Common Errors to Avoid • The AUS is secured to the vascular access
management of ectopic ureters • Avoid excessive dissection around the urethra port and inflated to check for leaks.
to minimize trauma to the blood supply. • The AUS is fully deflated and passed around
Contraindications • Postoperative urethral obstruction, dysuria, the urethra.
Patient unstable for surgery and urinary tract infection have been • The cuff must be oriented such that the
reported. actuating tubing is directed cranially.
Equipment, Anesthesia • The port is disconnected from the AUS
• General anesthesia is required Procedure temporarily to tunnel the tubing through
• Artificial urethral sphincter port system • The patient’s skin is aseptically prepared from the abdominal wall lateral to the rectus
(Norfolk Vet Products) xiphoid to pubis. abdominis muscle, where the port will be
○ AUS • A caudal approach to the abdomen is secured to the external rectus fascia.
○ Huber point needles performed by ventral midline celiotomy • The tubing is reconnected to the port, the
○ Vascular access port (Companion port, from the umbilicus to the pubic symphysis blue boot is advanced, and the port is sutured
three sizes available) for maximal exposure of the urethra. to the fascia using polypropylene suture.

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