Thursday, September 6, 2012

1082. Blocked bladder case - urethrotomy twice

Today, Dr Daniel operated on a Shih Tzu who could not pass urine. Vet 1 and Vet 2 in another ractice had operated and made two "holes" in the lower part of the penis ie. urethrotomy. This case was referred to him by his brother as the dog could not urinate and the dog owner was his brother's friend.

I reviewed this case done by my associate vets and discovered that this 4-year-old Shih Tzu had been examined by Dr Vanessa on Oct 24, 2011. She confirmed bladder stones from X-rays and the cathether was blocked about 6 cm from tip of penis. She recorded that the owner "declined all treatment."

The infected areas were cleared. The urethral opening was stitched again and a catheter was passed through. "Pus in the penis," he said to me. "According to the book, the penile head should have been amputated." I said: "Normally I don't do it. Just open the urethra behind the os penis to let the urine flow out if the front part is completely blocked. Only in this case, there were complications of infections after surgery done by Vets 1 and 2."

As more new vet surgery text books are produced, there are new concepts. Amputation of the penile head, in my opinion, is unnecessary despite what the new vet surgery text books say. I mean, this amputation causes more pain and bleeding and I have done urethrotomy without the need to cut off the penile head and the dog was OK. "The only problem with urethrotomy is that the male dog leaks urine onto the floor and the owner does not like cleaning up," I replied to him.

In urethrotomy, the owner needs to take special nursing care as the area can close up due to infections and scarring. So Vet 2 did another urethrotomy. This gave complications as the dog could not urinate. Vet 3 proposed another opening of the urethra further back.

In conclusion, this case would be difficult to treat. In my opinion, the solution is to open up the first urethral stricture. It must be debrided and opened up to join the 2nd one. Both stitched up as one opening ventral. A catheter is to be placed for over 10-20 days for healing to take place. Not just 4 days and take out the catheter as the urethral opening will closed up and obstruct urine flow again!


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