Comparison of surgical indications and short- and long-term complications in 56 cats undergoing perineal, transpelvic or prepubic urethrostomy.

Polina Stamenova,Maheeka Seneviratne,Karla Lee

doi:10.1177/1098612x20959032

Polina Stamenova, Maheeka Seneviratne + Show 1 more

Open Access

https://doi.org/10.1177/1098612x20959032

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Abstract

The aim of this study was to compare indications, complications and mortality rates for perineal urethrostomy (PU), transpelvic urethrostomy (TPU) and prepubic urethrostomy (PPU). A retrospective review of, and follow-up owner questionnaire for, cats undergoing urethrostomy between 2008 and 2018, at a single referral hospital, were performed. Fifty-six cats underwent urethrostomy (PU, n = 37; TPU, n = 8; PPU, n = 11). The presenting problem was significantly associated with urethrostomy technique (P <0.001). For PU cats, feline idiopathic cystitis (FIC; n = 21 [56.7%]) was the most common problem, whereas for PPU cats, trauma (n = 9 [81.8%]) was most common (P <0.001). Urethrostomy technique was associated with imaging diagnosis (P <0.001) of the urethral lesion. Most PU cats had no diagnostic imaging lesion (n = 15 [40.5%]) or obstructive calculi or clots (n = 10 [27.0%]), and all PPU cats had urethral rupture. Ten (90.9%) PPU cats had a pelvic lesion, while 21 (56.7%) PU cats had a penile lesion. TPU cats had a range of presenting problems and imaging diagnoses. Short- and long-term complications were reported in 33/55 (60.0%) and 11/30 (36.7%) cats, respectively. The number of cats with long-term complications was greater among PPU cats (P = 0.02). Short-term dermatitis (P = 0.019) and long-term incontinence (P = 0.01) were associated with PPU. Short-term mortality was 5.6% and long-term mortality was 13.3%; both were independent of urethrostomy technique. Quality of life post-urethrostomy, across all techniques, was graded as good by 93% of owners. In this study, PU was the most common feline urethrostomy technique indicated for FIC. Short-term urethrostomy complications are common, irrespective of urethrostomy technique. Long-term complications are less frequent but more common with PPU.

Highlights

Feline perineal urethrostomy (PU) is a salvage procedure that makes the narrow distal penile urethra redundant, by creating a permanent urethral opening between the wider, more proximal, pelvic urethra and the perineal skin
In this study, PU was the most common feline urethrostomy technique indicated for feline idiopathic cystitis (FIC)
Its primary indication is for male cats with recurrent urethral obstruction, due to feline idiopathic cystitis (FIC) that cannot be managed by urethral flushing and catheterisation.[1]

Summary

Introduction

Feline perineal urethrostomy (PU) is a salvage procedure that makes the narrow distal penile urethra redundant, by creating a permanent urethral opening between the wider, more proximal, pelvic urethra and the perineal skin. Feline prepubic urethrostomy (PPU) has been described as a technique to deal with a failed PU, irreparable injury of the intrapelvic urethra or congenital narrowing of the intrapelvic urethra.[3] In this surgery the pelvic urethra is transected as far caudally as possible, but proximal to the site of injury and sutured to the skin of the ventral midline, just cranial to the pubis.[3] Complication rates of up to 83.3% and mortality rates of up to 38% are reported, which appear to exceed those of PU.[4,5]

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