A urethrostomy is a surgical procedure that creates an opening in the urethra, the tube that carries urine from the bladder. The procedure is done to correct obstruction to urine flow, a life-threatening condition. Even partial obstruction to urine flow can lead to serious complications such as urinary tract infection and loss of bladder tone. A urethrostomy relives obstructions caused by stones, trauma, tumors, or scarring. A temporary opening that is later allowed to close is called a urethrotomy. A permanent opening is called a urethrostomy.
What Are the Indications for Performing a Urethrostomy?
Urethrostomy is indicated when the urethral opening is too narrow or persistently obstructed. This procedure is most often used in male dogs prone to bladder stones that enter the urethra and obstruct urine flow. While some dogs with urinary calculi (stones) respond to diet and medication, others experience persistent stone formation and recurrent episodes of urinary obstruction. In these dogs, surgery may be the best treatment. Urethrostomy also is indicated in cases of severe penile trauma or scarring that does not allow for normal passage of urine.
What Preoperative Tests Are Needed Before a Urethrostomy?
Preoperative tests depend in part on the age and general health of the animal as well as the cause for the urethrostomy. If treatment for urinary obstruction is the cause, simple blood tests, such as a packed cell volume or blood count and a biochemical profile should be done to evaluate kidney function. An abdominal x-ray or ultrasound of the bladder may be done to determine if stones are present. If the need for urethrostomy is related to major trauma to the area, more extensive tests such as radiographs (x-rays), blood count, serum biochemical tests, a urinalysis, and possibly an EKG may be necessary. Creation of the urethrostomy may even be delayed until the animal is stabilized and more severe injuries are treated.
What Type of Anesthesia is Needed For a Urethrostomy?
As in human patients, the procedure in dogs requires general anesthesia to induce complete unconsciousness, relaxation, and relief of pain. In the usual case, the pet receives a pre-anesthetic sedative-analgesic drug to help him relax, a brief intravenous anesthetic to allow placement of a breathing tube in the windpipe, and inhalation (gas) anesthesia in oxygen during the actual surgery.
How Is the Urethrostomy Operation Done?
Following anesthesia, the pet is placed on a surgical table, typically lying on his back. The hair is clipped around the area selected for the surgery. Depending on the reason for the urethrostomy, the surgery site may be in front of the scrotum (a prescrotal urethrostomy), over the scrotum, or between the scrotum and the rectum. After clipping, the skin is scrubbed with surgical soap to disinfect the area. A sterile drape is placed over the surgical site, and a scalpel is used to incise the skin. Your veterinarian will have to dissect surrounding tissues until the urethra is exposed, and then will make an incision in the urethra and possibly a portion of the penis. The surgeon will suture the edges of the urethra to the edges of the skin incision to create a wide urethral opening. Some surgeons choose to use absorbable sutures (stitches) that dissolve over time. Other surgeons use non-absorbable sutures that need to be removed in about 10 to 14 days. When the procedure is done to intact dogs, castration is usually performed as the same time. That procedure is explained elsewhere on this site.
How Long Does the Urethrostomy Procedure Take?
The procedure takes about 45 minutes to an hour in most cases, including the needed time for preparation and anesthesia. In cases of severe trauma or scarring, the procedure can take longer and may require two surgeons or referral to a board-certified surgical specialist.
What Are the Risks and Complications of a Urethrostomy Operation?
The overall risk of this procedure in a healthy dog is very low. The major risks are those of general anesthesia, bleeding (hemorrhage), post-operative infection, and wound breakdown (dehiscence) over the incision. Future scar formation closing off the urethra and preventing urination is another potential complication and does occur in a small percent of dogs. While the overall complication rate is low, a serious complications can result in death or the need for additional surgery.
What Is the Typical Postoperative Aftercare for a Urethrostomy?
Postoperative medication may be given to relieve pain, which is judged in most cases to be mild to moderate, and can be effectively eliminated with safe and effective pain medicines. The home care requires reduced activity until the stitches are removed in 10 to 14 days and preventing the dog from chewing or licking at the sutures. This may require a restraining collar around the neck for a week or two. If your dog allows, you should inspect the suture line daily for signs of redness, discharge, swelling, or pain. Monitor your dog for normal urination. Any inability to urinate should be reported promptly to your veterinarian. After healing, the surgical area has a good cosmetic result. Recognize that with a permanent urethrostomy the urine stream in male dogs will no longer be oriented through the end of the penis, instead the dog will void across the surgical opening near the scrotum. In a prescrotal urethrostomy, the urine will exit near the end of the penis.
How Long Is the Hospital Stay?
The typical stay following urethrostomy surgery is 2-3 days but will vary depending on the overall health of the pet, kidney function, and his ability to urinate following surgery.