TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

“TEKNIK OPERASI UTHROTOMY DAN URETHROSTOMY”

Oleh :

I Komang Ari Windhu Sancaya 1609511102

Putu Kreshna Medha 1609511106

I Putu Sandika Arta Guna 1609511110

I Gede Made Andy Pratama 1609511113

Ade Hary Wiweka 1609514084

LABORATORIUM ILMU BEDAH KHUSUS VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

DENPASAR

2019
 RINGKASAN
Urethrotomy adalah pembedahan pada urethra dengan melakukan insisi
pada urethra untuk mengeluarkan adanya kalkuli. Urethrostomy adalah tindakan
pembedahan dengan membuat saluran/lubang permanen pada urethra. Pada
prinsipnya teknik operasi urethrotomy dan urehtrostomy memiliki kesamaan. Pada
urethrotomy dilakukan pembedahan pada uretra untuk mengeluarkan kalkuli atau
urolithiasis. Sedangkan pada urethrostomy dilakukan pembedahan untuk membuat
suatu saluran atau lubang yang permanen pada uretra. Selain itu pada urethrostomy
mukosa uretra dijahit dengan kulit luar preputium sehingga terbentuklah saluran
permanen pada uretra untuk penegluaran urin.

SUMMARY
Urethrotomy is surgery on the urethra by making an incision in the urethra
to remove the calculi. Urethrostomy is a surgical procedure by making a permanent
channel/hole in the urethra. In principle urethrotomy and urehtrostomy surgery
techniques have in common. Urethrotomy is performed surgically on the urethra to
remove calculi or urolithiasis. Whereas the urethrostomy is surgically removed to
make a permanent channel or hole in the urethra. Also on urethrostomy the urethra
mucosa is sewn with the outer skin of the prepuce to form a permanent channel in
the urethra for urinary discharge.

ii
 KATA PENGANTAR

Puji syukur pada kami panjatkan kepada kehadirat Tuhan Yang Maha Esa,
karena berkat rahmat-Nyalah, kami dapat menyelesaikan paper Ilmu Bedah Khusus
Veteriner yang berjudul “Teknik Operasi Urethrotomy dan Urethrostomy” tepat
pada waktunya.
Adapun paper ini kami selesaikan untuk memenuhi tugas yang telah
diberikan kepada kelompok kami tentang Teknik Operasi Urethrotomy dan
Urethrostomy. Dengan adanya tugas mengenai Teknik Operasi Urethrotomy dan
Urethrostomy diharapkan dapat menambah wawasan untuk pembaca juga penulis.
Kami menyadari bahwa paper ini masih jauh dari kesempurnaan. Oleh
karena itu, kritik dan saran sangat dibutuhkan oleh penulis, agar paper ini bisa
menjadi lebih baik lagi.

Denpasar, 23 September 2019

Penulis

iii
 DAFTAR ISI
HALAMAN SAMPUL.................................................................................... i

RINGKASAN.................................................................................................. ii

KATA PENGANTAR ..................................................................................... iii

DAFTAR ISI.................................................................................................... iv

BAB I PENDAHULUAN ............................................................................... 1

1.1 Latar Belakang .................................................................................... 1

1.2 Rumusan Masalah................................................................................ 1

1.3 Tujuan Penulisan ................................................................................. 2

1.4 Manfaat Penulisan ............................................................................... 2

BAB II TINJAUAN PUSTAKA

2.1 Definisi Urethrotomy .......................................................................... 3

2.2 Definisi Urethrostomy......................................................................... 3

2.3 Teknik Operasi .................................................................................... 3

BAB III PREOPERASI DAN ANASTESI ..................................................... 4

BAB IV PROSEDUR OPERASI

4.1 Operasi Urethrotomy........................................................................... 5

4.2 Operasi Urethrostomy ......................................................................... 5

4.3 Pasca Operasi....................................................................................... 9

BAB V PENUTUP

5.1 Kesimpulan .......................................................................................... 11

5.2 Saran .................................................................................................... 11

DAFTAR PUSTAKA

iv
 BAB I
PENDAHULUAN
1.1 Latar Belakang
Uretra merupakan bagian terpenting dari saluran kemih. Uretra berbentuk
seperti saluran dan mempunyai fungsi utama untuk mengalirkan urin keluar
dari tubuh. ukuran uretra yang kecil menyebabkan resiko terbentuk kalkuli
atau striktura disepanjang uretra semakin tinggi. Pada striktur uretra terjadi
penyempitan dari lumen uretra akibat terbentuknya jaringan fibrotik pada
dinding uretra atau adanya urolithiasis berupa kalkuli. Striktura dan
urolithiasis pada uretra menyebabkan gangguan dalam berkemih, mulai dari
aliran berkemih yang mengecil sampai sama sekali tidak dapat mengalirkan
urin keluar dari tubuh. Urin yang tidak dapat keluar dari tubuh dapat
menyebabkan banyak komplikasi, dengan komplikasi terberat adalah gagal
ginjal.
Striktura dan urolithiasis merupakan masalah yang sering ditemukan pada
hewan khususnya hewan kecil seperti kucing dan anjing. Striktur dan
urolithiasis lebih sering terjadi pada hewan jantan dibandingkan dengan hewan
betina, karena uretra pada hewan betina lebih pendek diandingkan dengan
hewan jantan. Salah satu cara untuk mengobati kejadian striktura dan
urolithiasis adalah melalui pembedahan. Pembedahan pada uretra disebut
dengan uretrotomy atau uretrostomy. Pada paper ini penulis akan membahas
mengenai bagaimana teknik dalam melakukan operasi uretrotomy dan
uretrostomy.

1.2 Rumusan Masalah

1.2.1 Bagaimana teknik pre-operasi dan anestesi operasi uretrotomy dan
uretrostomy ?
1.2.2 Bagaimana prosedur teknik operasi uretrotomy dan uretrostomy ?

1.2.3 Bagaimana Hasil dan Pasca uretrotomy dan uretrostomy?

1
1.3 Tujuan
1.3.1 Untuk mengetahui teknik pre-operasi dan anestesi operasi uretrotomy
dan uretrostomy ?
1.3.2 Untuk mengetahui prosedur teknik operasi uretrotomy dan uretrostomy ?
1.3.3 Untuk mengetahui Hasil dan Pasca operasi uretrotomy dan uretrostomy ?

1.4 Manfaat

Melalui makalah ini diharapkan para mahasiswa dapat mengerti dan

mengetahui apa yang dimaksud dengan uretrotomy dan uretrostomy serta
bagaimana tekni operasi uretrotomy dan uretrostomy.

2
 BAB II
TINJAUAN PUSTAKA
2.1 Definisi Urethrotomy

Urethrotomy adalah pembedahan pada urethra dengan melakukan insisi

pada urethra untuk mengeluarkan adanya kalkuli. Sebelum dilakukan urethrotomy
perlu dilakukan kateterisasi untuk mendorong kalkuli ke kantong kencing.
Apabila kalkuli cukup besar dan tidak memungkinkan untuk mendorong ke
kantong kencing baru dilakukan pembedahan ini. Diusahakan sedapat mungkin
melakukan cystotomy untuk menghindari stricture urethra. (Sudisma, 2016)

2.2 Definisi Urethrostomy

Urethrostomy adalah tindakan pembedahan dengan membuat
saluran/lubang permanen pada urethra. Pembedahan ini dilakukan bila urethra
mengalami trauma berat, stricture urethra setelah dilakukan pembedahan pada
urethra atau kalkuli urethra yang kambuhan.(Sudisma, 2016) Lokasi dilakukannya
tindakan uretrostomy didasarkan pada lokasi ditemukannya kalkuli atau
urolithiasis.

2.3 Teknik Operasi

Pada prinsipnya teknik operasi urethrotomy dan urehtrostomy memiliki

kesamaan. Pada urethrotomy dilakukan pembedahan pada uretra untuk
mengeluarkan kalkuli atau urolithiasis. Sedangkan pada urethrostomy dilakukan
pembedahan untuk membuat suatu saluran atau lubang yang permanen pada
uretra. Selain itu pada urethrostomy mukosa uretra dijahit dengan kulit luar
preputium sehingga terbentuklah saluran permanen pada uretra untuk penegluaran
urin.
Anastesi yang digunakan pada operasi urethrotomy maupun urethrostomy
adalah anstesi umumu, epidural atau anastesi local. Apabila hewan mengalami
uremia berat akibat obstruksi kalkuli maka sebaiknya menggunakan anastesi local
atau epidural.

3
 BAB III
PREOPERASI DAN ANASTESI
• Persiapan ruang operasi
Ruang operasi dibersihkan dari kotoran dengan disapu (dibersihkan dari
debu), kemudian meja operasi disterilisasi dengan alkohol 70%.
• Preoparasi alat.
a. Sterilisasi alat-alat bedah
Sterilisasi pada alat-alat bedah bertujuan untuk menghilangkan
seluruhmikroba yang terdapat pada alat-alat bedah, agar jaringan
yang sterilatau pembuluh darah pada anjing yang akan dibedah
tidakterkontaminasi.
• Persiapan hewan kasus :
a. Hewan yang akan dioperasi dilakukansignalemen,anamnesa,
danpemeriksaan klinik. Sebelum dilakukan operasi, hewan dipuasakan
selama 12 jam agar hewan tidak muntah pada waktu teranaesthesia.
b. Kemudian diinjeksi dengan premedikasi yaitu atropin sulfat sebanyak1ml
secara subkutan (dosis terlampir).
c. Setelah 10 menit, kemudian di anestesi menggunakan kombinasi xylazin
dan ketamin dengan jumlah pemberian anestesi masing-masing0,5ml
xylazin dan0,3ml ketamin secaraintramuskuler(dosisterlampir).
d. Setelah teranestesi, Hewan ditempatkan pada posisi dorsalrecumbency.
e. Hewan disiapkan secara aseptik,bulu disekitar daerah yang akandiinsisi
dibersihkan. Kemudian dilakukan pemasangan Endotraceal Tube (ETT)
dan dilakukan pemasangan intravena kateter untuk infusNaCl 0,9%.
f. Dilakukan penutup ansiteoperasi dengan kain drape.
g. Kemudian diberi antiseptik untuk menjaga kondisi aseptik.

4
 BAB IV

PROSEDUR OPERASI

4.1 Pada Operasi Urethrotomy

1. Pada operasi Urethoromy, Hewan/Pasien akan dibaringkan dengan posisi

rebah dorsal Dan dilakukan anetesi,
2. Anestesi yang digunakan pada operasi Urethrotomy adalah anestesi umum.
Setelah teranestesi,
3. Insisi akan dilakukan pada urethra antara os penis dan skrotum melalui
prescrotalis, lalu kalkuli dikeluarkan dan dilanjutkan pembilasan,
4. Pemasangan kateter yang fleksibel dipasangkan dari tempat insisi sampai
vesica urinaria untuk memastikan tidak ada kalkuli lain.
5. Setelah itu dijahit dengan benang plain catgut 3/0 dan kulit dengan
benang non-absorbable, dengan pola interupted suture

4.2 Pada Operasi Urethrostomy

Menurut Saroglu et al,(2003) operasi urethrostomy memiliki kesamaan
denga operasi Urethrotomy, yang mebedakan adalah Urethrostomy dilakukan
untuk membuat saluran permanen di uretra sedagkan Urethrotomy untuk
pengangkatan kalkuli. Prosedur Urethrostomy dimulai dari:
1. Pasien dibaringkan dengan posisi Trienburg dan di anestesi dengan
anestesi umum
2. insisi dengan bentuk elips dibuat pada bagian scrotum dan region
perinal.
3. Kemudian dilakukan pemotongan pada bagian penis hingga ke
jaringan bulbourethralis.
4. Membran mukosa dari preputium dengan hati-hati diinsisi dan
disisihkan dari bagian penis.
5. Untuk menyamakan anastomosisnya, insisi kecil kemudian dibuat
pada bagian garis tengah dari dinding bagian dalam mukosa
preputium. Sedangkan, bagian tubular dari preputium disiapkan
untuk anastomosis.

5
6. Bagian ligament ventral dari penis dan otot bilateral
ischiocavernosus didiseksi dilanjutkan dengan pemisahan dari
sambungan dari pelvis yang sebelumnya pada bigan penis
dipisahkan bagian ventral dan lateralnya.
7. Otot retractor penis kemudian dipotong hingga ke bagian glandula
bulbourethralis sehingga urethra terlihat.
8. Setelah dilakukan kateterisasi dari bagian lumen urethra dengan
menggunakan kateter untuk kucing jantan kemudian lumen urethra
dipotong dengan menggunakan gunting iris sepanjang 1 cm dari
glandula bulbourethralisnya.
9. Kateter kemudian digantikan dengan kateter berdiameter 2,6 mm
ke arah pelvis urethra.
10. Bagian distal dari penis kemudian diamputasi dan dilakukan
penyatuan dengan benang poliglactin 910 ukuran 4-0 dengan
memiliki jarak 1 cm hingga ke ujung insisi dari urethra di bagian
penis.
11. Untuk tindakan anastomosisnya digunakan material yang sama
dengan bentuk sutura matrass dan dilakukan pada setiap insisi
mulai dari bagian ujung atas insisi hingga ke bagian dorsal mukosa
preputium dan kemudian dianjutkan dengan menggunakan ligasi
menerus berlapis.
12. Jaringan pada bagian subkutan dijahit dengan menggunakan
material catgut silk dan vicryl ukuran 3-0 dan 4-0.

6
 Insisi Elips pada Scrotum

Kucing yang sudah dikastrasi

Persiapan anastommis

7
 Penis dipotong hingga kelenjar bulbourethralis

Pemasangan kateter Anastomosis pada preputium

dan pelvis urethra

Luka sayatan dijahit dengan 10 hari pasca operasi

catgut silk ukuran 3-0

8
4.3 Pasca Operasi

4.3.1 Komplikasi

Komplikasi yang paling umum ditemukan pasca operasi

urethrostomy adalah pendarahan pada titik urethrostomy, infeksi bakteri,
dan striktura. Namun selain komplikasi yang dapat terjadi pada anjing
pasca operasi ini adalah Allen et al melaporkan bahwa 5 anjing
percobaanya tidak menunjukan ketimpangan pasca operasi bahkan pada
hari pertama, selain itu Yoon et al melaporkan bahwa 7 anjing
percobaannya dapat berjalan pasca 3 hari operasi, dimana dari hasil
percobaan tersebut menunjukan bahwa prosedur ini cukup efektif untuk di
lakukan (Katayama, 2011). Pemberian antibiotika untuk mencegah
terjadinya infeksi selama 5 hari atau lebih. Antiseptika dapat diolesi pada
luka operasi setiap hari untuk mempercepat terjadnya kesembuhan. Setelah
dilakukan urethrotomy biasanya dilanjutkan dengan operasi cystotomy
karena sering ditemukan juga kalkuli pada kantong kemih. Kateter tetap
dipertahankan selama proses kesembuhan, bilamana diputuskan untuk
melakukan cystotomy perlu diperhatikan terhadap status atau kondisi
pasien (Marzok, 2013).

4.3.2 Perawatan Pasca Operasi

Adapun terapi-terapi yang diberikan pada pasien pasca operasi
urethrostomy untuk menghindari komplikasi (Seddek, 2013) :
1. Pemberian antibiotik claviseptin (tablet) 2 kali sehari selama 2 minggu.
2. Pemberian anti-inflamasi carprofen (tablet) 2 kali sehari atau meloxicam
(cair) 1 kali sehari selama beberapa hari. Penggunaan meloxicam
diberikan bersamaan dengan makanan namun meloxicam dapat
menyebabkan muntah atau diare.
3. Pemberian analgesik tramadol (tablet) 2 kali sehari selama periode pasca
operasi dini.
4. Pemberian povidone iodine dan salep nitrofurazone

9
Selain terapi menggunakan obat, terapi medis lainnya berupa pemakaian
Elizabeth colar selama 2 minggu pasca operasi untuk melindungi luka.
Jahitan dapat dilepas setelah 2 minggu atau lebih pasca operasi, pengecekan
ulang disarankan untuk dilakukan setelah 2 minggu pasca operasi saat
melepaskan jahitan dan pengecekan keadaan umum pasien. Sekaligus dapat
menghentikan penggunaan Elizabeth collar, bagi pemilik untuk tetap
memperhatikan hewannya untuk tidak banyak melakukan gerakan seperti
melompat atau memanjat. Pastikan pintu dan jendela senantiasa tertutup.
Membuat keadaan tenang pada pasien dapat melalui pemberian transquilizer
agar pasien tidak terlalu hiperaktif, bagi pemilik untuk tetap mengamati
apakah proses urinasi hewan sudah normal karena beberapa hari pasca operai
biasanya ditemukan frekuensi urinasi sedikit dan disertai darah, tes
laboratorium dilakukan untuk mendokumentasikan fungsi ginjal dengan cara
memeriksa darah dan urine pasien.. Tes ini akan sangat berguna untuk
perencanaan jangka panjang, memberikan asupan air yang cukup untuk
menjaga urine tetap encer dan mengurangi kemungkinan kulkulus terbentuk
kembali. Di salah satu sumber menyarankan untuk memberikan air hujan
sebagai air minum karena air hujan tidak memiliki mineral terlarut
dibandingkan air biasa yang kemungkinan mengandung kalsium karbonat
(Kalim, 2011).

10
 BAB VI
PENUTUP

5.1 Kesimpulan
Urethrotomy adalah pembedahan pada urethra dengan melakukan
incisi pada urethra untuk mengeluarkan adanya urolithiasis atau kalkuli.
Urethrostomy adalah tindakan pembedahan dengan membuat saluran atau
lubang permanen pada uretra. Pada prinsipnya teknik operasi urethrotomy
dan urehtrostomy memiliki kesamaan. Pada urethrotomy dilakukan
pembedahan pada uretra untuk mengeluarkan kalkuli atau urolithiasis.
Sedangkan pada urethrostomy dilakukan pembedahan untuk membuat suatu
saluran atau lubang yang permanen pada uretra. Anastesi yang digunakan
pada operasi urethrotomy maupun urethrostomy adalah anstesi umumu,
epidural atau anastesi local.
5.2 Saran
Hewan yang mengalami urolithiasis harus segera dilakukan tindakan
operasi agar peluang sembuhnya lebih besar. Untuk mencegah kambuhnya
penyakit urolithiasis maka komposisi makanan harus tepat agar nutrisi dalam
tubuh anjing dapat seimbang
Dalam melakukakan operasi urethrotomy dan urethrostomy harus
dilakukan dengan seksama dan teliti sehingga tidak menimbulkan komplikasi
dan kalkuli ataupun striktura yang bersifat kambuhan pada hewan.

11
 DAFTAR PUSTAKA

Kalim, M. O., R. Zaman, S. K. Tiwari. 2011. Surgical Management of Obstructive

Urolithiasis in a Male Cow Calf. India: College of Veterinary Science and
Animal Husbandry, Anjora.

Katayama, M. (2011). Urinary Diversion Via Preputial Urethrostomy With

Bilateral Pubic-ischial in a Dog. Urinary Diversion Via Preputial
Urethrostomy With Bilateral Pubic-ischial in a Dog, 5.

Marzok, MA and El-khodery, S.A. A comparison of surgical outcomes of

perineal urethrostomy plus penile resection and perineal urethrostomy in
twelve calves with perineal or prescrotal urethral dilatation. Open
Veterinary Journal, (2013), Vol. 3(2): 106-113

Saroglu, M., S. E. Acar, O. Duzgun. 2003. Urethrostomy Done Using The

Anastomosis Technique of Prepuce Mucosa to The Pelvic Urethra in Cats
with Penile Urethral Obstruction. Turkey: Istanbul University Faculty of
Veterinary Medicine.
Seddek, Aiman Mahmoud, Hossam Ahmad Bakr. 2013. New Surgical Technique
for Treatment of Obstructive Penile Urethrolithiasis Interference with
Breeding Capability: Clinical Study on 25 Calves. Egypt: University of
Agriculture, Faisalabad.

Sudisma, I.G.N. 2016. Ilmu Bedah Veteriner dan Teknik Operasi.Bali : Udayana
University Press

12
 Turk. J. Vet. Anim. Sci.
2012; 36(6): 730-733
© TÜBİTAK
Case Report doi:10.3906/vet-1105-35

Urinary diversion via preputial urethrostomy with bilateral

pubic-ischial osteotomy in a dog

Masaaki KATAYAMA1,*, Yasuhiko OKAMURA1, Hiroaki KAMISHINA2, Yuji UZUKA1

1
Division of Small Animal Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Iwate University,
3-18-8 Ueda, Morioka, Iwate 020-8550 – JAPAN
2
Division of Veterinary Clinical Radiology, Department of Veterinary Medicine, Faculty of Applied Biological
Sciences, Gifu University, 1-1 Yanagido, Gifu, Gifu 501-1193 – JAPAN

Received: 25.05.2011 ● Accepted: 23.12.2011

Abstract: A 4-year-old, 8.7-kg intact male Pekingese dog was presented with stricture of the urethral opening after
a perineal urethrostomy revision surgery. Total penile amputation and preputial urethrostomy with bilateral pubic-
ischial osteotomy were performed. After surgery, the dog was able to urinate through the natural preputial orifice,
avoiding urine scalding associated with urethral anastomosis to the adjacent skin. Nine months after surgery, no major
complications were noted with the exception of a small amount of urine dribbling after urination.

Key words: Preputial urethrostomy, bilateral pubic-ischial osteotomy, dog

Introduction of urethrostomy is obviously different from the

Perineal urethrostomy in dogs is indicated for
severe damage, stricture, or loss of the urethra at or
proximal to the site of scrotal urethrostomy. However,
complications are common during and after this
surgical procedure, including severe hemorrhage
of the urethral opening site and unacceptable urine
scald dermatitis (1). Furthermore, postoperative
stricture formation could occur when undue tension
develops on the suture line of the urethrostomy
site. In case of urethral stricture, prepubic or
transpelvic urethrostomy may be considered as
salvage procedures (2–4). However, complications
such as urinary obstruction, urine scalding, urinary
incontinence, and urinary tract infections are also
common with these procedures. In addition, the
appearance of the external stoma after this type
* E-mail: masaaki@iwate-u.ac.jp
appearance of the normal anatomic structures.
In the present report preputial urethrostomy
was performed in a male Pekingese dog as a salvage
procedure for urethral stricture of the perineal
urethrostomy site. This procedure resulted in a more
acceptable cosmetic appearance. In addition, pubic-
ischial osteotomy was simultaneously performed to
obtain an adequate pelvic urethral length, preventing
undue tension at the urethral opening site.
Case history
A 4-year-old, 8.7-kg intact male Pekingese dog was
examined by the referring veterinarian for a sudden
onset of vomiting and dysuria. A blood examination
revealed azotemia. On abdominal ultrasonography,
urinary calculi were lodged in the bladder and pelvic

730

Figure 1. Stabilization of the bone plate with an 18-gauge
orthopedic wire at 4 points.
urethra. In order to remove the calculi, cystotomy
and perineal urethrotomy were performed, followed
by perineal urethrostomy. At that time, a new urethral
opening was made at the perineal urethrotomy site
after removal of the calculi. Stone analysis revealed
struvite uroliths, and a special prescription diet
(c/d dry, Hill’s) was fed to dissolve the crystals
after surgery. One and a half months later, stricture
formation of the urethral opening was confirmed and
revision surgery was performed. However, complete
resolution was not achieved.
The dog was referred to the Veterinary Teaching
Hospital of Iwate University for salvage urinary
diversion surgery 2 months after the second surgery.
Introduction of a <4-Fr catheter was possible,
indicating severe stricture of urethral stoma. The
results of the complete blood count were within
normal limits. Serum biochemistry panels revealed
only slight elevation of alkaline phosphatase. No
crystals were found by urinalysis.
Total penile amputation and preputial
urethrostomy with bilateral pubic-ischial osteotomy
were performed to create a permanent urinary
diversion. The dog was premedicated with
butorphanol (0.2 mg/kg intravenously [IV]) and
midazolam (0.3 mg/kg IV). Anesthesia was induced
with propofol (4 mg/kg IV to effect) and maintained
with sevoflurane in 100% oxygen. A balanced
electrolyte solution (lactated Ringer’s solution at
M. KATAYAMA, Y. OKAMURA, H. KAMISHINA, Y. UZUKA
Figure 2. Preservation of the pelvic urethral length after total
penile amputation. Babcock forceps were passed
through the small incision made by a biopsy punch
(small arrow). The length of the pelvic urethra was
preserved (large arrow).
an hourly rate of 10 mL/kg) was administered.
Antibiotics (cefmetazole sodium, 25 mg/kg IV) were
administered at anesthetic induction and 2 h later,
and then continued twice a day for 7 days.
With the animal in dorsal recumbency, a caudal
ventral midline abdominal incision was performed
followed by scrotal ablation and castration. A ventral
midline preputiotomy incision was performed to
access the penis and preputial cavity. After releasing
the penis from the prepuce, the penis was reflected
caudally and the ischiocavernosus and ischiourethralis
muscles were transected close to their origins at the
ischial arch. The pubic symphysis was exposed by
subperiosteally elevating the adductor muscles until
half of the obturator foramen was exposed. The
prepubic tendon was transected along the pubis to the
proposed osteotomy site. Holes (diameter: 1.7 mm)
were drilled in the pubis and ischium on both sides of
the 4 proposed osteotomy sites. The pubic and ischial
osteotomies were performed with an electronic
sagittal saw (Colibri, Synthes Vet, Switzerland),
and the central bone plate was removed. The pelvic
urethra was separated from the surrounding tissues
and reflected cranially. The bony plate was placed
back to its original location and stabilized with
18-gauge orthopedic wire, passing through the
previously drilled holes (Figure 1). The penis was
731
Urinary diversion via preputial urethrostomy with bilateral pubic-ischial osteotomy in a dog
Figure 3. The urethral opening was sutured to the preputial
mucosa in a simple interrupted pattern with 5-0
monofilament suture material.
completely removed by transecting the pelvic urethra
immediately proximal to the bulbospongiosus
muscles. The distal aspect of the pelvic urethra was
exteriorized though a small incision, made by a
disposable biopsy punch (BP-40F, Kai Industries,
Japan) lateral to the linea alba, within the prepuce
(Figure 2). The urethra was spatulated and sutured
to the preputial mucosa using simple interrupted 5-0
monofilament absorbable sutures (Figure 3). In order
to prevent stricture formation of the urethral opening,
a 10-Fr balloon catheter was kept in place for 2 weeks
after surgery. The mucosa and skin were reapposed
separately using a simple interrupted pattern with
5-0 monofilament absorbable suture and staples,
respectively. The adductor muscles and prepubic
tendon were reapposed using a simple interrupted
pattern with 2-0 monofilament absorbable suture
before closing the linea alba. The remaining wound
was closed in a routine fashion.
The dog recovered uneventfully from anesthesia
and surgery. Buprenorphine (0.02 mg/kg) was
administered subcutaneously to control pain. On the
14th postoperative day, a retrograde contrast study
of the urethra and bladder revealed that they were
positioned almost perpendicular to the abdominal
wall (Figure 4). After removal of the urinary catheter,
the dog could urinate without difficulty with urine
passing out of the preputial orifice. Nine months after
surgery, the owner noticed a small amount of urine
732
Figure 4. Retrograde contrast study of the bladder and urethra
showing their perpendicular position to the abdominal
wall.
dribbling from the preputial orifice immediately after
urination. However, he was very satisfied with the
functional and cosmetic outcome.
Discussion
Preputial urethrostomy was reported to be effective as
a salvage procedure in dogs that required a prepubic
urethrostomy secondary to intrapelvic urethral
trauma with subsequent stricture formation (2).
Pavletic and O’Bell applied preputial urethrostomy
to a dog with penile necrosis (5). To our knowledge,
these are the only published reports of the use of
preputial urethrostomy in dogs. This technique uses
the preputial cavity as a site for urethral anastomosis.
Therefore, the dog can urinate through the natural
orifice, avoiding the potential for urine scalding
associated with urethral anastomosis to the adjacent
skin. In our case, urine dribbling immediately after
urination was observed. This likely resulted from the
temporal accumulation of small amounts of urine
in the preputial cavity. This may be prevented by
reconstruction of a smaller cavity when the prepuce
is sutured.
In Bradley’s study (2), a caudal abdominal
ventral midline incision to access the bladder and
proximal urethra was made. However, the size of
the prostate gland limited the amount of urethra
that was brought through the abdominal incision.
Pelvic symphysiotomy and bilateral pubic-ischial

osteotomy have been reported in order to gain access
to, evaluate, and treat intrapelvic urethral disorders
and neoplasms such as rectal, prostatic, vaginal, and
urethral tumors (6,7). By combining these procedures
with urethrostomies, a sufficient urethral length can
be preserved. This may maintain urinary continence
and reduce tension at the urethrostomy site,
avoiding postoperative stricture formation. Pelvic
symphysiotomy can expose the intrapelvic structures
in a less invasive manner than bilateral pubic-ischial
osteotomy. Bilateral pubic-ischial osteotomy may
be more appropriate for lesions that require greater
exposure compared to pelvic symphysiotomy. In our
case, pubic-ischial osteotomy was simultaneously
performed. The reluctance to use these procedures is
attributed to postoperative complications, including
inability to ambulate, prolonged recovery period,
and degree of difficulty of the approach. Allen et
al. (7) reported that 5 experimental dogs did not
References
1. Smeak, D.D.: Urethrotomy and urethrostomy in the dog. Clin.
Techn. Small Anim. Pract., 2000; 15: 25–34.
2. Bradley, R.L.: Prepubic urethrostomy. An acceptable urinary
diversion technique. Probl. Vet. Med., 1989; 1: 120–127.
3. Boothe, H.W.: Managing traumatic urethral injuries. Clin.
Techn. Small Anim. Pract., 2000; 15: 35–39.
4. Liehmann, L.M., Doyle, R.S., Powell, R.M.: Transpelvic
urethrostomy in a Staffordshire bull terrier: a new technique in
the dog. J. Small Anim. Pract., 2010; 51: 325–329.
5. Pavletic, M.M., O’Bell, S.A.: Subtotal penile amputation and
preputial urethrostomy in a dog. J. Am. Vet. Med. Assoc., 2007;
230: 375–377.
M. KATAYAMA, Y. OKAMURA, H. KAMISHINA, Y. UZUKA
show lameness postoperatively, even on the first
postoperative day. In addition, Yoon et al. (8) reported
that 7 dogs that underwent bilateral pubic-ischial
osteotomy could ambulate normally within 3 days
after surgery. In our case, the dog was ambulatory
the day after surgery. These results may suggest
that protracted disability should not be anticipated
in most animals undergoing bilateral pubic-ischial
osteotomy.
In conclusion, urinary diversion via preputial
urethrostomy and total penile amputation could
provide a normal anatomical appearance and prevent
postoperative urine scalding. Bilateral pubic-ischial
osteotomy facilitates the use of the entire length of
the pelvic urethra. This series of procedures may
be considered to be a surgical option for urethral
disorders proximal to the scrotal lesion. Future
studies with a larger number of cases are warranted
to further evaluate postoperative complications.
6. Davies, J.V., Read, H.M.: Sagittal pubic osteotomy in the
investigation and treatment of intrapelvic neoplasia in the dog.
J. Small Anim. Pract., 1990; 31: 123–130.
7. Allen, S.W., Crowell, W.A.: Ventral approach to the pelvic canal
in the female dog. Vet. Surg. 1991; 20: 118–121.
8. Yoon, H.Y., Mann, F.A.: Bilateral pubic and ischial osteotomy
for surgical management of caudal colonic and rectal masses
in six dogs and a cat. J. Am. Vet. Med. Assoc. 2008; 232: 1016–
1020.
733
Vet. Med. – Czech, 48, 2003 (8): 229–234 Original Paper

Urethrostomy done using the anastomosis technique

of the prepuce mucosa to the pelvic urethra in cats
with penile urethral obstruction
M. S������, S.E. A���, O. D�����

Surgery Department, Faculty of Veterinary Medicine, Istanbul University, Avcilar,

Istanbul, Turkey

ABSTRACT: Penile urethral obstruction in cats is a commonly seen clinical manifestation. In cases where there is
no response to catheterisation and medical intervention, surgery is needed to provide urination and correct uremia
and hyperkalemia. Several surgical techniques have been described. The perineal urethrostomy technique, reported
by Wilson and Harrison in 1971, has been used extensively and since then various modifications of this technique
have been developed by other researchers. In 2000, Yeh and Chin described a modified perineal urethrostomy tech-
nique created by use of the prepuce mucosa. This technique was used in our clinic in 20 cats with penile urethral
obstruction. Seventeen cats recovered without complication. A 2.6 mm diameter catheter was placed in each of the
3 cases in which leakage was determined in the anastomosis site. The urine gathered in the site subcutaneously
was drained. Normal urination was achieved in 2 of the 3 patients treated with this technique. The remaining case
was re-operated and the perineal urethrostomy technique, in which the urethra was sutured to the perineal skin
(the Wilson and Harrison method, 1971), was applied. The advantages of this technique over the classical perineal
urethrostomy technique are; return to urination shortly a�er the operation, be�er urination potential compared to
normal cats, a more aesthetic appearance compared to other techniques (similar to a castrated cat), no narrowing
of the orifice caused by re-growth of hair. It was also understood that, anastomosis of the urethra and the prepuce
mucosa must be carried out with utmost care in order to prevent urine leakage.

Keywords: urethrostomy; cat; penile urethral obstruction

The urethra of the male cat is divided into 4
sections: the pre-prostatic urethra, the prostatic
urethra, the post-prostatic urethra and the penile
urethra. The penile urethra narrows towards the
end of the penis. Obstruction of the penile urethra
by crystal plaques and urethral calculi is due to its
anatomic structure (Osborne et al., 1996a). The most
important causes of urethral obstruction are; stru-
vite crystals, calcium oxalate crystals and accumula-
tion of cells due to urinary tract infections. Strictures
occurring in the penis and the penile urethra also
play a role (Arikan and Acar, 1993). K retention and
hyperkalemia also develop in this condition, as well
as inability to urinate and uremia. Hyperkalemia
causes destruction of the cell membrane potential
and ventricular fibrillation. All these negative de-
velopments carry life risk for the patient (Drobatz
and Hughes, 1997). It has also been reported that,
urethra atrophy may develop following castration
in male cats and this could create the risk of penile
urethra obstruction (Sevestre, 1979).
The initial procedures to be carried out when
urine flow is obstructed are; catheterization of the
urethra, rectal massaging of the pelvic urethra and
decompressing of the bladder via cystocentesis. In
some patients, medical treatment may be effective
along with these methods (Arikan and Acar, 1993;
Yucel, 1998). As long as the urine can be expressed,
special diets selected according to laboratory re-
sults may prevent crystal development (Osborne
et al., 1991, 1996a). However, recurrence is pos-
sible and when these procedures are ineffective,
surgical intervention is indicated (Christensen,
1964; Mendham, 1970; Johnson, 1974; Long, 1977;
Osborne et al., 1996a,b; White et al., 1997; Akin and
Samsar, 1998; Folder, 1999; McLoughlin, 2000).
Several surgical methods and their modifications
have been described for the treatment of penile

229
Original Paper
urethra obstruction in cats. Antepubic urethros-
tomy, urethrocolostomy-uretherocolostomy, pe-
nile urethrostomy and perineal urethrostomy are
techniques which have been used since the 1950s.
The perineal urethrostomy technique reported
by Wilson and Harrison in 1971 has been used
extensively and since then various modifications
of this technique have been developed by different
researchers.
Arikan and Acar (1993) performed the perineal
urethrostomy technique in 17 male cats with ure-
thral obstruction. One of these cases died during
the operation and stenosis developed in one other
cat 3 months a�er surgery.
In relation to penile urethra obstruction, com-
plications such as; death due to anaesthesia,
Figure 1. Appearance of the eliptical incision including
the scrotum and the perineal region
Figure 3. The tubular prepuce mucosa prepared for ana-
stomosis
230
Vet. Med. – Czech, 48, 2003 (8): 229–234
post-operative haemorrhage, subcutaneous urine
accumulation, irritation dermatitis, perineal hernia,
stricture, urinary incontinence, urethrorectal fistula
and urinary system infections (USI) may develop
(Gregory and Vasseur, 1984; Gregory et al., 1984;
Griffin and Gregory, 1992; Osborne et al., 1991,
1996a; Kyles and Stone, 1998).
In a study they published in 2000, Yeh and Chin
described a modified perineal urethrostomy tech-
nique using the prepuce mucosa. They reported un-
complicated recovery in all cases where they used
this technique in 14 cats with urethral obstruction.
Advantages of this technique are; return to urina-
tion shortly a�er the operation, be�er urination po-
tential compared to normal cats, a more aesthetic
post-operative appearance of the region compared
Figure 2. Castrated appearance of a sexually active cat
Figure 4. Dissection of the penis until the bulbourethral
glands
Vet. Med. – Czech, 48, 2003 (8): 229–234
to other techniques (same as castrated healthy cats),
no development of irritation dermatitis in the surgi-
cal site and no narrowing of the orifice caused by
re-growth of hair.
MATERIAL AND METHOD
The material of the study included 20 cats with
obstructed urethras which could not be unblocked
neither via catheterizing nor rectal massaging. Six
of these patients had previously been castrated.
The patients were given a premedication of atro-
pine sulphate (Atropin®, Vetas, Istanbul, Turkey)
and diazepam (Diazem®, Deva, Istanbul, Turkey),
followed by general anaesthesia induced by i.v. ad-
Figure 5. Application of a 2.6 mm-diameter catheter via
the incision in the pelvic urethra
Figure 7. Appearance of the operation site closed using
3/0 silk suture
Original Paper
ministration of ketamine hydrochlorure (Ketalar®,
Pfizer Warher Lambert, Istanbul, Turkey). Following
intubation, the animals were connected to a closed
circuit anaesthesia machine and anaesthesia was
maintained using halothane (Fluothane®, Astra
Zeneca, Istanbul, Turkey) or isoflurane (Forane®
likid, Abbot, Istanbul, Turkey).
The patients were placed in the Trienburg position
and an elliptical incision was made including the
scrotum and perineal region (Figure 1). Sexually
intact cats were castrated (Figure 2). The penis was
dissected until it was free from the surrounding
loose connective tissue. The mucosal membrane of
the prepuce was carefully incised around the pe-
nis and freed. In order to match the anastomosis,
a small incision was also made on the midline of
Figure 6. Anastomosis of the prepuce mucosa and the
pelvic urethra
Figure 8. Castrated male cat appearance of the patient
whose sutures were removed 10 days a�er surgery
231
Original Paper
the interior wall of the prepuce mucosa. Thus, the
tubular prepuce mucosa was prepared for anasto-
mosis (Figure 3).
The ventral ligament of the penis and the bilat-
eral ischiocavernosus muscles were cut. Careful
dissection of the penis was continued in the ventral
and lateral directions and pelvic connections were
separated (Figure 4). Thus, the penis was freed
further. The retractor muscle of the penis was ex-
cised until the bulbourethral glands and the penile
urethra was reached. After catheterization of the
urethra lumen with a male cat urinary catheter, the
lumen was excised using iris scissors to within 1
cm of the bulbourethral glands. The catheter was
replaced with a 2.6 mm-diameter catheter in the
direction of the pelvic urethra (Figure 5). The dis-
tal portion of the penis was amputated after plac-
ing a ligature using 4/0 polyglactin 910 (Vicryl®,
Ethicon, Edinburgh, United Kingdom) suture
material approximately 1 cm distal to the incision
in the penile urethra.
For the anastomosis, 4/0 polyglactin 910 suture
material was used. Matress suture was applied to
the upper end of the incision in the pelvic urethra
and the most dorsal portion of the prepuce mucosa,
this was continued with a continuous suture and
a full-layer anastomosis was achieved (Figure 6).
The surrounding so� tissue and subcutaneous
connective tissue was closed using 4/0 polyglactin
910 and the skin was closed using 3/0 silk suturing
material (Figure 7).
Broad spectrum antibiotics were administered to
all patients for postoperative 5 days. The patients
wore Elizabethan collars for 10 days. The skin su-
tures were removed on postoperative Day 10. The
surgical site had the appearance of a castrated male
cat (Figure 8).
Findings
Ages of the 20 male cats (6 of which had been
castrated previously) included in the study changed
between 1 and 12. The mean age was found to be 4.6.
Of the patients, 2 were Persian cats, 2 Van cats and
the remaining 16 were mixed breed. The patients
were cases in which urination could not be achieved
in spite of medical treatment either in our clinic or
at private veterinary surgeons. In the biochemical
check-ups of the blood sera done before the opera-
tion, urea and creatinine values were above normal
in all cases.
232
Vet. Med. – Czech, 48, 2003 (8): 229–234
The serum urea level of case No. 3 before the
operation was 433 mg/dl and creatinine value
was 36 mg/dl. In the post-mortem examination of
this case that died on post-operative Day 2, while
there were no complications related to the operation
technique, the reason of death was understood to
be nephrosis.
The edema formed post-operatively in the peri-
neal region of case No. 4 made urination difficult.
Urine flow was achieved with support by ab-
dominal palpation until post-operative Day 7. The
edema resolved a�er Day 8 and normal urination
was achieved.
Seventeen patients recovered without any com-
plication. Subcutaneous urine accumulation was
observed in the surgical site in 3 patients which
developed post-operative complications. This was
seen to have been caused by urine leakage between
the anastomosed urethra and prepuce mucosa.
These patients were re-catheterized using 2.6 mm
diameter catheters, 2 of the sutures in the incision
site were removed and the region was drained.
The catheters were removed 5 days later from one
patient and 15 days later in one other and urination
returned to normal. In the third patient, however,
difficulty to urinate was found to originate from
the stricture which had developed, whereupon the
patient was re-operated using the classical perineal
urethrostomy technique.
According to the information received from the
patient owners for the late period check-ups, one
case had died in a traffic accident, another patient
had died due to reasons unrelated to urination
problems and that the remaining 15 cases were
continuing their lives without any problems.
RESULTS AND DISCUSSION
Castration in male cats has been reported to be a
possible cause of urethra atrophy and in relation to
this, penile urethra obstruction (Sevestre, 1979). On
the other hand, the fact that only 6 of the 20 cats in-
cluded in this study had been previously castrated,
indicates that urethral obstruction is not necessarily
seen in every castrated cat.
The most frequent complication in the classical ure-
throstomy technique is the narrowing of the orifice
and the development of a stenosis. The perineal hair
growing back in a few months also contributes to this
narrowing (Carbone, 1963; Blake, 1968; Wilson and
Harrison, 1971; Arikan and Acar, 1993; Osborne et al.,
Vet. Med. – Czech, 48, 2003 (8): 229–234
1996b). No such complications were encountered in
the new technique used in this study. This supports
the views of Yeh and Chin (2000) .
In the classical urethrostomy technique, urine
frequently causes irritation dermatitis in the peri-
neal region where it is in contact with the skin at
the site it is expressed (Osborne et al., 1996b). In
the technique developed by Yeh and Chin (2000),
it has been stressed that because urine is expressed
directly outwards from the prepuce, irritation der-
matitis does not occur and the appearance of the
site is like that of a castrated male cat. The findings
of this study are similar to these views.
In all the patients to which they applied prepucial
urethrostomy, Yeh and Chin (2000) reported that, the
potential to urinate was much higher than normal
cats. In our study, with the exception of 3 cases with
urine leakage and 1 case with edema in the perineal
region, the remaining 16 cases confirmed this view.
According to Yeh and Chin (2000), anastomo-
sis leakage was not seen in any of the 17 cats. In
this study, which was carried out using the same
technique, there was an anastomosis leakage in
3 of 20 cats. We think that this was due to lack
of experience. The most important stage of the
technique is the anastomosis stage. Subcutaneous
urine accumulation was relieved by catheterizing
and draining the urine from the region in 2 of 3 cats.
The patient in which narrowing had developed in
the anastomosis site at the same time was treated
with the classical perineal urethrostomy technique.
This indicates that, even if urine leakage developed
in the prepucial urethrostomy technique, the patient
could be treated with alternative methods.
In case No. 3, pre-operative serum urea level was
433 mg/dl and creatinine level was 36 mg/dl. In the
post-mortem examination of the patient that died on
post-operative Day 2, there were no complications re-
lated to the surgical technique and the cause of death
was understood to be nephrosis. This is a significant
warning against delaying the time of surgery.
In the light of these assessments, we would like
to state that the technique we applied in this study
has many advantages over other techniques used
in our clinic over the years and that we can highly
recommend it to practicing colleagues.
REFERENCES
Akin F., Samsar E. (1998): Special Surgery (in Turkish).
Tamer Publishing House, Ankara.
Original Paper
Arikan N., Acar S.A. (1993): Urethral obstruction in male
cats and urethrostomy (in Turkish). Journal of the
Faculty of Veterinary Medicine University of Istanbul,
19, 39–47.
Blake J.A. (1968): Perineal urethrostomy in cats. J. Am.
Vet. Med. Assoc., 152, 1499–1506.
Carbone M.G. (1963): Perineal urethrostomy to relieve
urethral obstruction in male cat. J. Am. Vet. Med. As-
soc., 143, 34–39.
Christensen N.R. (1964): Preputial urethrostomy in male
cat. J. Am. Vet. Med. Assoc., 145, 903–908.
Drobatz K.J., Hughes D. (1997): Concentration of ionized
calcium in plasma from cats with urethral obstruction.
J. Am. Vet. Med. Assoc., 211, 1392–1395.
Folder W.R. (1999): Calcium oxalate urolithiasis in a cat.
Feline Pract., 27, 17–20.
Gregory C.R., Vasseur P.B. (1984): Electromyographic and
urethral pressure profilometry: Long-term assessment
of urethral function a�er perineal urethrostomy in cats.
Am. J. Vet. Res., 45, 1318–1321.
Gregory C.R., Holliday T.A., Vasseur P.B., Parker H.R.
(1984): Electromyographic and urethral pressure pro-
filometry: assessment of urethral function before and
a�er perineal urethrostomy in cats. Am. J. Vet. Res., 45,
2062–2065.
Griffin D.W., Gregory C.R. (1992): Prevalence of bacterial
urinary tract infection a�er perineal urethrostomy in
cats. J. Am. Vet. Med. Assoc., 200, 681–684.
Johnson D.E. (1974): Feline urethrostomy – a critique and
new method. J. Small Anim. Pract., 15, 421–435.
Kyles A.E., Stone E.A. (1998): Urethra. In: Bojrap M.J.
(eds.): Current Techniques in Small Animal Surgery.
4th ed. Williams & Wilkins, Baltimore. 461–477.
Long R.D. (1977): A technique for perineal urethrostomy
in the cat. J. Small Anim. Pract., 18, 407–413.
McLoughlin M.A. (2000): Surgical emergencies of the
urinary tract. Veterinary Clinics of North America:
Small Anim. Pract., 30, 581–601.
Mendham J.H. (1970): A description and evaluation of
antepubic urethrostomy in the male cat. J. Small Anim.
Pract., 11, 709–721.
Osborne C.A., Caywood D.D., Johnston G.R., Polzin D.J.,
Lulich J.P., Kruger J.M. (1991): Perineal urethrostomy
versus dietary management in prevention of recurrent
lower urinary tract disease. J. Small Anim. Pract., 32,
296–305.
Osborne C.A., Kruger J.M., Lulich J.P., Bartges J.W., Polzin
D.J. (1996a): Medical management of feline urethral
obstruction. Veterinary Clinics of North America: Small
Anim. Pract., 26, 483–498.
Osborne C.A., Caywood D.D., Johnston G.R., Polzin D.J.,
Lulich J.P., Kruger J.M., Ulrich L.K. (1996b): Feline
233
Original Paper Vet. Med. – Czech, 48, 2003 (8): 229–234

perineal urethrostomy. Veterinary Clinics of North
America: Small Anim. Pract., 26, 535–549.
Sevestre J. (1979): Elements de Chirurjie Animale. Chiru-
rgie abdominale. Tome 2. Les editions du point veteri-
naire, Paris. 149–157.
White R.N., Tick N.T., White H.L. (1997): Naturally oc-
curring xanthine urolithiasis in a domestic shorthair
cat. J. Small Anim. Pract., 38, 299–301.
Wilson G.P., Harrison J.W. (1971): Perineal urethrostomy
in cats. J. Am. Vet. Med. Assoc., 159, 1789–1793.
Yeh L.S., Chin S.C. (2000): Modified perineal urethros-
tomy using preputial mucosa in cats. J. Am. Vet. Med.
Assoc., 216, 1092–1095.
Yucel R. (1998): Veterinary Special Surgery (in Turkish).
2nd ed. Pethask Publishing House, Istanbul.
Received: 03–01–06
Accepted a�er corrections: 03–06–12

Corresponding Author

Dr. Murat Saroglu, Istanbul University, Faculty of Veterinary Medicine, Surgery Department, 34851-Avcilar,
Istanbul, Turkey
Tel. +90 212 591 69 84, fax +90 212 591 69 76, e-mail: muratsaroglu@yahoo.com

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