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Use of fluoroscopically guided percutaneous antegrade urethral catheterization for the treatment of urethral obstruction in male cats: 9 cases (2000–2009)

Elaine S. HolmesMatthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Chick WeisseMatthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Allyson C. BerentMatthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

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Abstract

Objective—To describe the technique and determine outcome for male cats with urethral obstruction treated with fluoroscopically guided percutaneous antegrade urethral catheterization (PAUC).

Design—Retrospective case series.

Animals—9 client-owned neutered male cats with urethral obstruction and inability to pass a retrograde urinary catheter.

Procedures—Information regarding the procedure and hospitalization was obtained from medical records. Long-term follow-up was obtained via medical record review or telephone interview.

Results—Diagnoses included iatrogenic urethral tear (n = 6), obstructive urethral calculi (1), urethral ulceration (1), and urethral stricture (1). Seven of the 9 procedures were successful. The 2 patients in which PAUC failed had mechanical obstructions preventing guide wire access across the urethral obstruction. Procedure times ranged from 25 to 120 minutes. No complications were noted in any patients during the procedure. One patient was euthanized because of unrelated disease. Follow-up information was available for 6 of 8 surviving patients. No complications that could be directly attributed to the procedure were noted. All 6 patients had a perineal urethrostomy performed 0 days to 6 weeks following the procedure because of reobstruction of the lower urinary tract. None of these patients had documented urethral strictures and none had recurrence of clinical signs following perineal urethrostomy.

Conclusions and Clinical Relevance—Results suggested that PAUC can be a simple, rapid, minimally invasive, and safe technique to facilitate transurethral catheterization in select cases. Patients with iatrogenic urethral tears may be good candidates. Patients with impacted urethral calculi, severe strictures or ulcerations, or a nondistended urinary bladder may be less amenable to PAUC.

Abstract

Objective—To describe the technique and determine outcome for male cats with urethral obstruction treated with fluoroscopically guided percutaneous antegrade urethral catheterization (PAUC).

Design—Retrospective case series.

Animals—9 client-owned neutered male cats with urethral obstruction and inability to pass a retrograde urinary catheter.

Procedures—Information regarding the procedure and hospitalization was obtained from medical records. Long-term follow-up was obtained via medical record review or telephone interview.

Results—Diagnoses included iatrogenic urethral tear (n = 6), obstructive urethral calculi (1), urethral ulceration (1), and urethral stricture (1). Seven of the 9 procedures were successful. The 2 patients in which PAUC failed had mechanical obstructions preventing guide wire access across the urethral obstruction. Procedure times ranged from 25 to 120 minutes. No complications were noted in any patients during the procedure. One patient was euthanized because of unrelated disease. Follow-up information was available for 6 of 8 surviving patients. No complications that could be directly attributed to the procedure were noted. All 6 patients had a perineal urethrostomy performed 0 days to 6 weeks following the procedure because of reobstruction of the lower urinary tract. None of these patients had documented urethral strictures and none had recurrence of clinical signs following perineal urethrostomy.

Conclusions and Clinical Relevance—Results suggested that PAUC can be a simple, rapid, minimally invasive, and safe technique to facilitate transurethral catheterization in select cases. Patients with iatrogenic urethral tears may be good candidates. Patients with impacted urethral calculi, severe strictures or ulcerations, or a nondistended urinary bladder may be less amenable to PAUC.

Contributor Notes

Dr. Holmes' present address is the Veterinary Specialty Hospital of the Carolinas, 6405 Tryon Rd, Cary, NC 27511.

Drs. Weisse and Berent's present address is the Animal Medical Center, 510 E 62nd St, New York City, NY 10065.

Presented in part in the Residents Forum at the American College of Veterinary Surgeons Symposium, Washington DC, October 2009.

Address correspondence to Dr. Holmes (elaineh@vshcarolinas.com).