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Management of a urethral tear with porcine small intestinal submucosa–augmented urethroplasty and balloon dilation for subsequent urethral stricture in a cat

Vanna M. DickersonFrom the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602

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Janet A. GrimesFrom the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602

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Tracy L. HillFrom the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602

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Joseph W. BartgesFrom the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602

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Chad W. SchmiedtFrom the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602

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Abstract

CASE DESCRIPTION

As a result of vehicular trauma, a 3-year-old neutered male domestic shorthair cat sustained luxation of the sacrocaudal joint and a urethral tear.

CLINICAL FINDINGS

Retrograde contrast urethrocystography revealed a urethral tear at the level of the ischiatic tuberosity. Conservative treatment for 7 days with a urethral catheter was unsuccessful.

TREATMENT AND OUTCOME

An approach for a perineal urethrostomy was performed and revealed a large urethral tear (4 mm in length in a craniocaudal orientation and encompassing approx 50% of the urethral circumference) proximal to the bulbourethral glands. Urethroplasty was performed with a graft of a rectangular section of single-layer porcine small intestinal submucosa. Perineal urethrostomy was then completed routinely, and a urethral catheter was left in place for 5 days. Two days after removal of the urethral catheter, stranguria was noted. Retrograde contrast urethrocystography revealed a urethral stricture. Balloon dilation of the urethral stricture was performed, and the cat's stranguria improved. Ten weeks following balloon dilation, the cat developed hematuria, and a urinary tract infection and urethral stricture were diagnosed. Balloon dilation was repeated with instillation of triamcinolone solution at the stricture site. Eighteen months later (approx 21 months after the initial surgery), the cat was urinating normally.

CLINICAL RELEVANCE

The outcome for the cat of this report indicated that porcine small intestinal submucosa may be used to successfully augment urethroplasty for treatment of traumatic urethral tears in cats. Urethral balloon dilation with triamcinolone instillation may be used to treat postoperative urethral strictures.

Abstract

CASE DESCRIPTION

As a result of vehicular trauma, a 3-year-old neutered male domestic shorthair cat sustained luxation of the sacrocaudal joint and a urethral tear.

CLINICAL FINDINGS

Retrograde contrast urethrocystography revealed a urethral tear at the level of the ischiatic tuberosity. Conservative treatment for 7 days with a urethral catheter was unsuccessful.

TREATMENT AND OUTCOME

An approach for a perineal urethrostomy was performed and revealed a large urethral tear (4 mm in length in a craniocaudal orientation and encompassing approx 50% of the urethral circumference) proximal to the bulbourethral glands. Urethroplasty was performed with a graft of a rectangular section of single-layer porcine small intestinal submucosa. Perineal urethrostomy was then completed routinely, and a urethral catheter was left in place for 5 days. Two days after removal of the urethral catheter, stranguria was noted. Retrograde contrast urethrocystography revealed a urethral stricture. Balloon dilation of the urethral stricture was performed, and the cat's stranguria improved. Ten weeks following balloon dilation, the cat developed hematuria, and a urinary tract infection and urethral stricture were diagnosed. Balloon dilation was repeated with instillation of triamcinolone solution at the stricture site. Eighteen months later (approx 21 months after the initial surgery), the cat was urinating normally.

CLINICAL RELEVANCE

The outcome for the cat of this report indicated that porcine small intestinal submucosa may be used to successfully augment urethroplasty for treatment of traumatic urethral tears in cats. Urethral balloon dilation with triamcinolone instillation may be used to treat postoperative urethral strictures.

Contributor Notes

Dr. Dickerson's present address is the Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843.

Address correspondences to Dr. Dickerson (vmdickerson@cvm.tamu.edu).