Urinary bladder retroversion and neourethrocystostomy for treatment of inadvertent prostatectomy and urethrectomy in a dog

Kathryn Flesher Veterinary Specialists and Emergency Services, 825 White Spruce Blvd, Rochester, NY 14623.

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Chick Weisse Department of Interventional Radiology and Endoscopy, The Animal Medical Center, 510 E 62nd St, New York, NY 10065.
Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, 3900 Spruce Street, PA 19104.

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Allyson Berent Department of Interventional Radiology and Endoscopy, The Animal Medical Center, 510 E 62nd St, New York, NY 10065.
Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, 3900 Spruce Street, PA 19104.

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Rebecca Lin Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, 3900 Spruce Street, PA 19104.

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Abstract

CASE DESCRIPTION A 15-month-old male Newfoundland was examined because of an inability to urinate, lethargy, inappetence, and intermittent vomiting that first became evident after bilateral cryptorchidectomy 2 days previously. The patient was referred for further evaluation and treatment.

CLINICAL FINDINGS Results of physical examination, serum biochemical analysis, and abdominocentesis led to a diagnosis of uroperitoneum. Retrograde cystography indicated urinary tract obstruction. In view of the history of recent elective cryptorchidectomy, a diagnosis of uroperitoneum with urethral obstruction secondary to iatrogenic prostatectomy and urethrectomy was made.

TREATMENT AND OUTCOME During a ventral midline celiotomy, the inadvertent prostatectomy and urethrectomy were found to have resulted in insufficient urethral length for primary repair. Surgical repair of the urethral defect was achieved by means of a novel technique of bladder retroversion and neourethrocystostomy at the apex of the bladder. A urethral stricture evident 1.5 months after surgery was initially treated with balloon dilatation, followed by temporary and then permanent placement of a self-expanding metallic stent. At the last follow-up 6.6 years after stent placement, the dog remained continent while receiving phenylpropanolamine and the owner was highly satisfied with the outcome.

CLINICAL RELEVANCE Caudal intraabdominal bladder retroversion with apex neourethrocystostomy may be a viable alternative to more complex urethral lengthening procedures in dogs and can potentially preserve lower urinary tract function. This treatment might be considered for patients with urethral trauma or malignant neoplasia necessitating extensive urethral resection. Urethral strictures may be effectively managed with stenting.

Abstract

CASE DESCRIPTION A 15-month-old male Newfoundland was examined because of an inability to urinate, lethargy, inappetence, and intermittent vomiting that first became evident after bilateral cryptorchidectomy 2 days previously. The patient was referred for further evaluation and treatment.

CLINICAL FINDINGS Results of physical examination, serum biochemical analysis, and abdominocentesis led to a diagnosis of uroperitoneum. Retrograde cystography indicated urinary tract obstruction. In view of the history of recent elective cryptorchidectomy, a diagnosis of uroperitoneum with urethral obstruction secondary to iatrogenic prostatectomy and urethrectomy was made.

TREATMENT AND OUTCOME During a ventral midline celiotomy, the inadvertent prostatectomy and urethrectomy were found to have resulted in insufficient urethral length for primary repair. Surgical repair of the urethral defect was achieved by means of a novel technique of bladder retroversion and neourethrocystostomy at the apex of the bladder. A urethral stricture evident 1.5 months after surgery was initially treated with balloon dilatation, followed by temporary and then permanent placement of a self-expanding metallic stent. At the last follow-up 6.6 years after stent placement, the dog remained continent while receiving phenylpropanolamine and the owner was highly satisfied with the outcome.

CLINICAL RELEVANCE Caudal intraabdominal bladder retroversion with apex neourethrocystostomy may be a viable alternative to more complex urethral lengthening procedures in dogs and can potentially preserve lower urinary tract function. This treatment might be considered for patients with urethral trauma or malignant neoplasia necessitating extensive urethral resection. Urethral strictures may be effectively managed with stenting.

A 15-month-old 40.7-kg (89.7-lb) male Newfoundland was referred to the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania for evaluation of inability to urinate, lethargy, inappetence, and intermittent vomiting. The clinical signs were first observed after elective bilateral cryptorchidectomy performed by the referring veterinarian 2 days earlier. On initial physical examination, the dog was nonambulatory, appeared depressed, and had signs of pain on abdominal palpation. Rectal temperature was 39.5°C (103.1°F), respiratory rate was 60 breaths/min, and heart rate was 175 beats/min with subjectively weak peripheral pulse pressure. The dog had both prescrotal and caudal abdominal incisions, and an abdominal fluid wave was present on palpation. Serum biochemical analysis, abdominocentesis, abdominal radiography, and abdominal ultrasonography were subsequently performed.

Clinicopathologic abnormalities included azotemia with high BUN concentration (> 100 mg/dL; reference range, 6 to 25 mg/dL), high creatinine concentration (6.5 mg/dL; reference range, 0.5 to 1.6 mg/dL), hyperlactatemia (3.0 mmol/L; reference limit, < 2.5 mmol/L), and hyperkalemia (5.1 mEq/L; reference range, 3.6 to 5.0 mEq/L). Serosanguinous fluid obtained with abdominocentesis had a high BUN concentration (> 100 mg/dL; reference range, 6 to 25 mg/dL), a creatinine concentration that was too high to measure (reference range, 0.5 to 1.6 mg/dL), and a high potassium concentration (13.76 mEq/L; reference range, 3.6 to 5.5 mEq/L).

Results of abdominal radiography included distention of the abdomen and bladder with overall increased soft tissue opacity and poor serosal detail. Abdominal ultrasonography revealed free abdominal fluid with echogenic content within the effusion swirling in the vicinity of the neck of the bladder. The right ureter was normal in appearance, whereas the left ureter appeared mildly dilated (measurements unavailable). Dilation of the urethra further caudally was not evident, and no other ultrasonographic abnormalities were observed. To better evaluate suspected discontinuity of the lower urinary tract, retrograde positive-contrast cystourethrography was performed with fluoroscopic guidance. A 5F urinary catheter was introduced into the urethra, and resistance was encountered at the region of the pubis. Iohexola contrast medium was slowly infused (Figure 1), and an abrupt termination of contrast flow within the intrapelvic urethra was evident at the approximate level of the caudal aspect of the prostatic urethra. Contrast medium was not detected in the bladder. Percutaneous positive-contrast cystography was then performed with ultrasonographic guidance and injection (20-g IV catheter) of iohexola into the bladder lumen. Radiographs were obtained immediately and approximately 5 minutes after injection. Contrast was not seen entering the neck of the bladder or the urethra, and a site of bladder leakage was not identified.

Figure 1—
Figure 1—

Oblique and lateral radiographic views of the caudal portion of the abdomen in a 15-month-old Newfoundland referred because of an acute onset of inability to urinate, lethargy, inappetence, and intermittent vomiting. Clinical signs developed after elective bilateral cryptorchidectomy 2 days earlier. An initial diagnosis of uroperitoneum was made on the basis of results of physical examination, serum biochemical analysis, and abdominocentesis. A—Oblique image obtained during retrograde positive-contrast cystourethrography demonstrating urethral stricture with interruption of contrast flow (black arrow). The anatomic location of the prostatic urethra (white arrows) is not evident, confirming that there was a defect between the urinary bladder (UB) and urethra. B—Lateral image obtained during percutaneous, positive-contrast cystography confirming the presence of a urethral defect (white arrows) with contrast material evident within the urinary bladder (UB).

Citation: Journal of the American Veterinary Medical Association 248, 5; 10.2460/javma.248.5.538

On the basis of history and results of clinical examination and diagnostic imaging, a diagnosis of uroperitoneum with urethral obstruction secondary to inadvertent (iatrogenic) prostatectomy and urethrectomy was made. The owners elected to proceed with surgical treatment. The dog was anesthetized and aseptically prepared for surgery according to standard hospital protocol. A ventral midline celiotomy revealed a right intra-abdominal testis as well as multiple ligatures of chromic gut and polydioxanone suture material at the bladder neck and the urethral stump. The ligatures were removed, and an approximately 2- to 3-cm defect was identified in the congested, contused urinary bladder wall at the level of the trigone (Figure 2). The bladder neck, proximal portion of the urethra, and prostate were absent. A 0.25-inch Penrose drain was placed around the urethra to prevent further iatrogenic injury during manipulation. The UVJs (approx 1 to 2 mm from the excised edge) were catheterized with 5F red rubber catheters inserted via the bladder defect. Because of the proximity of the UVJs to the bladder defect, the margins of the lesion were minimally debrided with Metzenbaum scissors. The large (approx 7 to 8 cm) defect between the remaining urinary bladder trigone and the proximal extent of the pelvic urethra prevented primary appositional repair because of the immobility of both segments. The ureteral catheters were passed through an apical incision in the urinary bladder, and the bladder neck defect was repaired with 3–0 polydioxanone in a single-layer full-thickness simple interrupted pattern. The catheters were left in place during closure to ensure continued patency of the ureters. The apex of the bladder was gently manually retraced ventrally and caudally to position it in a retroverted position in the abdomen, and a dorsal cystotomy was performed near the apex of the bladder. A separate 5-mm incision was then made in the ventral wall of the bladder, and a 10F Foley urinary catheter was placed in a retrograde fashion. Babcock forceps were used to manipulate the urethral stump via this ventral incision near the apex of the bladder. Minimal debridement of the urethral stump was performed to minimize additional incisional tension. The urethral mucosa and submucosa were sutured to the bladder mucosa and submucosa with 4–0 polydioxanone in a simple interrupted pattern. The Foley catheter was passed into the bladder, and the balloon was inflated with sterile saline (0.9% NaCl) solution. Several full-thickness surgical biopsy samples of the bladder were obtained for histologic examination in addition to a mucosal swab specimen for aerobic and anaerobic microbial culture. The ureteral catheters were then removed and the cystotomy was closed with 3–0 polydioxanone in a simple interrupted pattern. The remaining cryptorchid testis was removed routinely with a 3-clamp technique and 2 circumferential ligatures of 3–0 polydioxanone. Prophylactic incisional gastro-pexy at the right abdominal wall was performed with size-0 polydioxanone in a simple continuous pattern. The surgical site and peritoneal cavity were lavaged with warm sterile saline solution, and the abdomen was closed routinely. Recovery from anesthesia was uneventful. A 10F Foley urinary catheter was placed to monitor urine output and prevent bladder distention for several days following surgery.

Figure 2—
Figure 2—

Intraoperative photographs of the dog in Figure 1 obtained during ventral midline celiotomy for treatment of urethral obstruction secondary to inadvertent prostatectomy and urethrectomy. Bladder retroversion with neourethrocystostomy was performed. A—A congested and contused urinary bladder (UB) is present with no bladder neck or prostate evident. The pubis is marked with a dashed white line. B—The ureters have been catheterized bilaterally with red rubber catheters (white arrows). Notice the proximity of the UVJs to the excised bladder neck. C—A 0.25-inch Penrose drain was used to isolate the distal urethral stump (black arrow), and a 7- to 8-cm defect is evident between the urethral stump and urinary bladder. The bladder neck defect has been repaired and the ureteral catheters have been passed through an apical cystostomy. D—The bladder has been retroverted, the apical cystostomy has been extended dorsally, and a small ventral cystostomy has been made. The urethral stump was grasped with Babcock forceps (large white arrow) via the small ventral cystotomy in the retroverted apex of the bladder. E—Closure of the neourethrocystotomy around a 10F Foley urinary catheter (black arrow) in the urethral stump (white arrow) is completed. F—The completed bladder retroversion with neourethrocystostomy is illustrated by the black arrow.

Citation: Journal of the American Veterinary Medical Association 248, 5; 10.2460/javma.248.5.538

Over the first 4 days after surgery, results of repeated serum biochemical analyses and urinalyses were within reference limits. Repeated abdominal ultrasonography performed 5 days after surgery revealed moderate bilateral pyelectasia (right, 10.8 mm; left, 9.1 mm) and hydroureter (right, 6.1 mm; left, 7.4 mm). Seven days after surgery, repeated ultrasonography confirmed persistent (right) and resolving (left) pyelectasia (right, 12 mm; left, 3.8 mm) and similar or improved hydroureter (right, 6.6 mm; left, 1.1 mm). The indwelling urinary catheter was removed, and results of bacterial culture of a urine sample were negative for bacterial growth. The dog was discharged 9 days after surgery, and the owner was instructed to administer tramadolb (3.6 mg/kg [1.6 mg/lb], PO, q 8 h) and to return for reexamination in 3 days. Results of histologic examination of bladder biopsy samples obtained at surgery were consistent with severe fibrosis with moderate pyogranulomatous inflammation.

At the first postoperative visit 12 days after surgery, the skin sutures were removed. Repeated abdominal ultrasonography confirmed similar or improved pyelectasia (right, 12 mm; left, 3.8 mm) and hydroureter (right, 6.6 mm; left, 1.1 mm). Serum biochemical analysis was also repeated (results unavailable). The owner reported that the dog was incontinent, dripping urine frequently and voiding large amounts of urine while lying down. On palpation, the bladder was soft and small. Phenylpropanolaminec (1.2 mg/kg [0.5 mg/lb], PO, q 12 h) was prescribed to treat the urinary incontinence. One week later (19 days after surgery), there was no improvement; therefore, bethanechold (0.25 mg/kg [0.1 mg/lb], PO, q 12 h) was added to treat suspected atonic bladder. At this time, repeated abdominal ultrasonography revealed continued resolution of the bilateral pyelectasia (right, 3.15 mm; left, 3.06) and right hydroureter (right, 4 mm; left, 2.28 mm). In addition, results of a urinalysis performed at that visit were indicative of a urinary tract infection (urine specific gravity, 1.017; pH, 5.0; 6 to 12 RBCs/hpf; 10 to 17 WBCs/hpf; and bacteriuria). Bacterial culture of a urine sample did not yield any growth; however, the patient received amoxicillin–clavulanic acide (12.5 mg/kg [6.25 mg/lb], PO, q 12 h for 14 days) pending these results.

One and a half months after surgery, the owners reported that the patient continued to dribble urine. Bacterial culture of a urine sample at that time was negative for microbial growth. Under general anesthesia, retrograde positive-contrast urethrocystography with fluoroscopic guidance was performed with a 50:50 combination of iohexola in sterile saline solution. A region of urethral narrowing was detected at the level of the vesicourethral anastomosis. A 7 × 2-mm balloon catheterf was placed in a retrograde fashion over a 0.035-inch angled hydrophilic guidewire,g and an inflationh device was used to monitor the balloon pressure. The balloon was advanced across the stricture and inflated to a pressure of 4,560 mm Hg for 3 minutes and then was deflated and removed. The procedure was then repeated with a 9 × 4-mm balloon catheterf that was inflated to 6,080 mm Hg for 3 minutes. The stricture was identified and effaced both times during balloon inflation (Figure 3). Retrograde positive-contrast urethrocystography was repeated and demonstrated effacement of the stricture and mild urethral spasm. The balloon catheter was replaced and again inflated to occlude the urethra, and with the balloon positioned immediately caudal to the stricture, mitomycin Ci was instilled adjacent to the stricture and allowed to dwell in the urethra for 5 minutes. The balloon was then deflated, the mitomycin C was aspirated, and the urethra was flushed with saline solution. The balloon catheter was withdrawn, and a 10F Foley catheter was placed and maintained in place for 6 days.

Figure 3—
Figure 3—

Serial lateral fluoroscopic images of the caudal portion of the abdomen of the dog in Figure 1 obtained 45 days after bladder retroversion with neourethrocystostomy. A—Image obtained following retrograde positive-contrast urethrography demonstrating a filling defect of the urethra at the level of the urethral anastomosis (white arrows) between the urethra and urinary bladder (UB). B—A guidewire and balloon dilation catheter (white arrows) have been passed through the stricture and inflated to efface the stricture (black arrow). C—Complete effacement of the urethral stricture is confirmed (white arrows) with full inflation of the balloon dilation catheter.

Citation: Journal of the American Veterinary Medical Association 248, 5; 10.2460/javma.248.5.538

The patient recovered without complications and was discharged from the hospital. After 6 days, the dog returned to the hospital and was again anesthetized and the Foley catheter was removed with fluoroscopic guidance. Severe urethral stricture was not present; however, there was evidence of mild narrowing at the stricture site. By the following day, the patient was observed to posture and void urine in small streams, but was not emptying the bladder completely. Therefore, following general anesthesia and standard aseptic preparation, a repeated midline laparotomy was performed. Exploration of the abdomen confirmed recurrent urethral stricture. The patient underwent a urethral bougienage procedure by means of a cystostomy, and a cut segment of an 18F red rubber catheter in which multiple side holes had been created was placed spanning the lesion, sutured in place with 2–0 polypropylene suture, and left in situ as a temporary stent (Figure 4). A urine sample obtained during surgery and sent for culture and susceptibility testing was positive for Staphylococcus intermedius susceptible to chloramphenicol.j This was prescribed (0.05 mg/kg [0.023 mg/lb], PO, q 8 h, for 28 days) to the dog at hospital discharge 3 days after surgery. After placement of the temporary stent, the patient continued to dribble urine but was able to posture and produce a normal stream of urine.

Figure 4—
Figure 4—

Intraoperative photographs of the dog in Figure 1 obtained during repeated ventral midline celiotomy performed 49 days after bladder retroversion with neourethrocystostomy. A—A vascular dilator (white arrows) has been advanced over a guide wire, through the cystostomy, and across the stricture. B—A temporary stent, a cut portion of a red rubber catheter (black arrows), was placed over a guide wire. Additional holes were cut in the catheter before it was secured within the urethra and bladder. C—The red rubber catheter (black arrow) was anchored in place as a temporary stent with polypropylene suture material (white arrow).

Citation: Journal of the American Veterinary Medical Association 248, 5; 10.2460/javma.248.5.538

The dog again returned to our hospital 2 months after placement of the fenestrated red rubber stent (3 months after the original surgery) for reexamination and stent removal. Prior to surgery, results of repeated abdominal ultrasonography were normal but retrograde positive-contrast urethrocystography identified tissue ingrowth cranial to and into the lumen of the red rubber catheter stent (Figure 5). Therefore, a routine cystotomy under general anesthesia was performed and the fenestrated red rubber catheter stent was removed. Postoperatively, the patient initially was able to urinate well without the stent but had persistent incontinence. Within 4 days after surgery, the patient was exhibiting stranguria again. Consequently, a permanent laser-cut, self-expanding metallic stentk was placed with fluoroscopic guidance (112 days after initial neourethrocystostomy). The patient was then discharged with instructions for the owner to administer carprofenl (2.5 mg/kg [1.1 mg/lb] in the morning and 1.8 mg/kg [0.8 mg/lb] in the evening, PO) and tramadolb (2.4 to 3.6 mg/kg [1.1 to 1.6 mg/lb], PO, q 12 h) for 7 days.

Figure 5—
Figure 5—

Serial lateral fluoroscopic images of the dog in Figure 1 obtained 112 days after bladder retroversion with neourethrocystostomy. A—Repeated retrograde positive-contrast urethrocystography demonstrated a filling defect (dotted line) at the cranial aspect of the red rubber catheter (arrows). B—Retrograde positive-contrast urethrocystography demonstrated a filling defect within the uncovered self-expanding metallic stent (arrows). A marker catheter is visible in place within the colon. C—Retrograde positive-contrast urethrocystography performed 119 days after bladder retroversion with neourethrocystostomy demonstrating a patent urethra (arrows) following placement of a covered self-expanding metallic stent within the previously occluded uncovered stent.

Citation: Journal of the American Veterinary Medical Association 248, 5; 10.2460/javma.248.5.538

One week later, the dog was reportedly dribbling urine at home with prolonged posturing and was producing a decreased stream of urine. The patient was readmitted and underwent repeated retrograde positive-contrast urethrocystography, which revealed persistent luminal narrowing within the urethral stent with ingrowth of tissue (Figure 5). Therefore, a new permanent covered self-expanding metallic stentm was placed within the first stent with fluoroscopic guidance. The patient was discharged to the owner the next day after it was observed to empty the bladder with no obvious signs of straining. Results of bacterial culture and susceptibility testing of a urine sample indicated a Pseudomonas aeruginosa urinary tract infection, and the patient was treated with enro-floxacinn (10 mg/kg [4.5 mg/lb], PO, q 24 h) and doxy-cyclineo (5 mg/kg [0.23 mg/lb], PO, q 12 h) for 5 days.

Results of a urinalysis performed 2 months later were within reference limits, and bacterial culture of a urine sample was negative for microbial growth. At the last follow-up via telephone interview 2,454 days (6.6 years) following placement of the permanent covered stent, the owners were very pleased with the results of treatment. The dog was noted to have a very strong urine stream with no signs of incontinence. The dog was monitored regularly by the primary care veterinarian with repeated urinalyses and urine cultures and had not had further urinary tract infections.

Discussion

The dog described in the present report developed uroperitoneum with urethral obstruction following inadvertent (iatrogenic) removal of the prostate and prostatic urethra during elective cryptorchid castration. Successful treatment of inadvertent prostatectomy requires surgical repair of the resultant defects. The primary challenges encountered in this case included the need to compensate for loss of length of the urethra, repair of friable and potentially devascularized tissues, and unknown risk of postoperative complications at the time of primary repair. Anticipated postoperative complications associated with surgical treatment of iatrogenic prostatectomy may include inflammation and scarring, resulting in obstruction of the UVJs, stricture and leakage or dehiscence at the neourethrocystostomy site, bladder and renal injury secondary to obstruction, surgical site infection, urethral stricture, and urinary incontinence.1,2 In addition, stranguria may occur as a result of urinary tract obstruction, infection, or inflammation.3

To our knowledge, this is the first report documenting urinary bladder retroversion to compensate for loss of the proximal portion of the urethra following inadvertent prostatectomy and urethrectomy. In previous cases of inadvertent prostatectomy, the dogs were treated by means of anastomosis of the bladder neck to the urethra.1,4,5 In the dog described in the present report, apposition of the bladder trigone to the urethral stump was not possible because of extensive urethral loss between the 2 remaining structures. We felt that more extensive dissection to mobilize the remaining viable urethral tissue would have increased the risk of further nerve and vascular compromise. Bladder retroversion in conjunction with neourethrocystostomy at the apex of the bladder allowed for a tension-free anastomosis between the congested bladder and proximal end of the urethra. At the time of the procedure, it was unclear how the loss of the prostatic urethra as well as the unique position of the bladder would affect the overall function of the lower urinary tract. It has been reported that injuries to either 1 or both lateral ligaments as well as inadvertent ligation, transection, or malpositioning of the bladder (ie, torsion) can result in vascular or neurologic compromise of the bladder with unknown subsequent effects on function and integrity.2 However, in the dog of this report, it was possible to relocate the bladder to a retroverted position without any apparent neurologic or vascular compromise. As such, the long-term outcome in this dog with acceptable continence suggested this technique may be a feasible option for future patients when excessive tension is anticipated with use of direct anastomotic repair.

When urethral anastomosis is used to repair damage secondary to prostatectomy, urethral stricture is a common complication because of compromised blood supply, suboptimal mucosal apposition with tension, and pooling of urine at the surgical site.6–9 For prevention of potential stricture formation in this patient, mitomycin C was instilled and allowed to remain in the urethra after the bougienage procedure. Mitomycin C is a chemotherapeutic agent with antifibroblast and anticollagen properties. It has been reported that treatment with mitomycin C can reduce stricture recurrence after internal urethrotomy in male human patients.10

Current recommendations for treatment of urethral strictures in dogs include balloon dilatation, urethral stenting, or surgical management including urethral resection and anastomosis or urinary bypass via urethrostomy or tube cystostomy.4,11,12 In dogs, urethral stents composed of the nickel-titanium alloy nitinol are most common, and either uncovered stents or stents coated with polytetrafluoroethylene or polyurethane are used.13,14 We have previously reported the use of uncovered nitinol stents in dogs as palliative treatment for obstructive urethral disease14 and for treatment of urethral carcinoma.3 Such stents may safely and effectively relieve urethral obstruction and improve urine outflow.3,14 Della Maggiore et al13 also recently reported the successful use of a self-expanding covered nitinol stent to treat an 8-month-old dog with traumatic stricture of the penile urethra believed to have occurred as a result of inadvertent trauma during elective castration.13

The most common complications we have observed in dogs with indwelling urethral stents are tissue or tumor ingrowth within or adjacent to the stent, incontinence, and urinary tract infection.3,14 Stents are purposefully oversized (ie, 110% of the desired lumen diameter),13 but care must be taken in size selection because use of inappropriately oversized stents (> 130% of lumen diameter) may cause higher, persistent, chronic outward force, which contributes to greater local tissue reaction and risk of stenosis at stent ends.13 In the dog of the present report, a red rubber catheter segment was temporarily sutured in place to minimize stricture recurrence, with the assumption it would eventually be removed. Subsequently, tissue ingrowth was noted so a permanent uncovered metal stent was placed. Finally, because of additional tissue ingrowth, a covered stent was placed within the original uncovered metal stent to ensure a patent lumen and prevent future tissue ingrowth through the stent interstices. Further complications including migration and severe incontinence14 were not encountered, and the owner was highly satisfied with the outcome.

The present report describes the course of treatment by means of bladder retroversion, neourethrocystostomy, and urethral stenting in a dog with loss of the proximal portion of the urethra following inadvertent prostatectomy and urethrectomy. This procedure may be considered as a potential treatment option for similar cases and may also have possible applications in patients with urethral trauma or malignant neoplastic disease when urethral resection results in large defects. Bladder repositioning as described may provide successful return of function and may be a viable alternative to more complex urethral lengthening techniques in affected patients.

ABBREVIATION

UVJ

Ureterovesicular junction

Footnotes

a.

Omnipaque 240, GE Healthcare Inc, Princeton, NJ.

b.

Tramadol, Caraco Pharmaceutical Laboratories, Detroit, Mich.

c.

Phenylpropanolamine, Pegasus Laboratories Inc, Pensacola, Fla.

d.

Bethanachol, Wockhardt Ltd, Parsippany, NJ.

e.

Clavamox, Pfizer Animal Health, New York, NY.

f.

Powerflex P3 Dilation Catheter, Cordis Europa NV, Roden, The Netherlands.

g.

Weasel Wire, Infiniti Medical LLC, Menlo Park, Calif.

h.

Encore inflation device, Boston Scientific Corp, Quincy, Mass.

i.

Mitomycin, Best Pet RX, New York, NY.

j.

Chloramphenicol, Biyeda Inc, Le Sueur, Minn.

k.

Vet Stent-Urethra, Infiniti Medical LLC, Menlo Park, Calif.

l.

Carprofen, Pfizer Animal Health, New York, NY.

m.

Fluency Stent, Bard Peripheral Vascular Inc, Tempe, Ariz.

n.

Enrofloxacin, Bayer Corp, Shawnee Mission, Kan.

o.

Doxycycline, PAR Pharmaceutical Inc, Spring Valley, NY.

References

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