Cystostomy Tube Research Articles

“Close-loop Urethral Stricture:" A Variant of Multiple Urethral Stricture Disease - Its Description, Management and Outcome: A Case Report

Abstract Urethral stricture disease is an abnormal narrowing and loss of distensibility of the urethra due to spongiofibrosis. It is commoner in young adult males. The management of this condition is diverse with various factors influencing the choice of treatment. However, length of the stricture is a major determinant of the choice of treatment. Two or more stricture sites close together are also treated as long segment stricture. Our aim is to describe a variant of multiple urethral strictures consisting of two short segment complete strictures involving the proximal bulbar urethral and urethral meatus with intervening significant length of normal urethra "close-loop stricture" in a 46-year old man who had traumatic urethral catheterization and was referred to the urology clinic six months following suprapubic tube cystostomy. KeywordsStricture, Meatotomy, Urethroplasty, Catheterization, Bouginage

Pharmacokinetics of oral phenazopyridine in goats with obstructive urolithiasis

Phenazopyridine, an azo dye and urinary bladder analgesic widely used in human medicine, is commonly used for ancil­lary pain management in the treatment of goats with obstruc­tive urolithiasis. Despite its common use in these patients, there are no published studies on the pharmacokinetic param­eters, safety, or efficacy of phenazopyridine in caprine patients. The aim of this study was to determine the pharmacokinetic pa­rameters of oral phenazopyridine administration in goats with obstructive urolithiasis following tube cystostomy surgery

Single-step, non-surgical placement of permanent low-profile cystostomy tubes in dogs: 10 cases (2018-2023).

Low-profile cystostomy tubes provide an alternative to conventional cystostomy tubes with external tubing. Previously, these have been placed surgically involving coeliotomy, cystotomy and cystopexy, or have been used as replacement tubes in existing stoma sites. The purpose of this study is to describe a technique for, and the outcomes of, single-step, non-surgical low-profile cystostomy tube placement. All cases that had single-step, non-surgical placement of low-profile cystotomy tube attempted at the authors' institutions were included in this study. Data, including success rates, outcomes and complications, were extracted from the medicalrecords. Ten client-owned dogs were inclided. Single-step, non-surgical placement was successful in eight out of 10 dogs, with placement being unsuccessful in two thus necessitating coeliotomy. The median duration that low-profile cystostomy tubes were in place was 7.0 months (range 4 days to 38 months). Seven of the eight dogs required replacement of their cystostomy tube. Mean time until first tube replacement was 103 days (range 13 to 363 days). Single-step, non-surgical placement of a low-profile cystostomy tube is a viable alternative to surgical placement. Lack of cystopexy does not appear to result in complications. Conversion to coeliotomy might be required if tube placement is not successful with this technique. Complications seen with non-surgical tube placement such as inadvertent tube removal were similar to those previously reported for surgically placed tubes.

Minimal Invasive percutaneous tube cystostomy using three-way Foley Catheter for management of obstructive urolithiasis in goats

Minimal Invasive percutaneous tube cystostomy using three-way Foley Catheter for management of obstructive urolithiasis in goats

Modified tube cystostomy technique for management of obstructive urolithiasis in small ruminants: procedure and outcome in 17 sheep and goats.

To describe the surgical technique and clinical outcome of small ruminants treated for obstructive urolithiasis using a modified tube cystostomy (MTC) technique. 15 goats and 2 sheep treated with an MTC between March 2018 and February 2023. Animals were diagnosed with obstructive urolithiasis on the basis of history, physical examination, and ultrasonographic examination. An MTC was performed with sedation and a local block. Postoperative medical management was instituted to help reestablish urethral patency, and Foley catheters were removed after successful urination. Animals were hospitalized an average of 3 nights (range, 0 to 14 nights). Complications included urine spillage in the abdomen and accidental deflation of the Foley balloon. Six animals were euthanized due to poor prognosis or failure to regain urethral patency. Foley catheters were removed an average of 15.7 days postoperatively in animals that regained urethral patency. Long-term (> 1-month) follow-up was available for 8 animals, with an average postoperative survival time of 19.4 months (range, 1 to 58 months). Four animals were lost to long-term follow-up. This MTC technique is an effective means of catheterizing the urinary bladder in small ruminants. It can be performed under field conditions and serve as a standalone procedure for providing temporary urine egress. Patient size is limited by the length of the introducer, and an intact, distended urinary bladder and plan for reestablishing urethral patency are important considerations.

Minimally invasive percutaneous tube cystostomy employing a Malecot catheter for the surgical treatment of urolithiasis in bucks

Minimally invasive percutaneous tube cystostomy employing a Malecot catheter for the surgical treatment of urolithiasis in bucks

Tube cystostomy is effective for urinary outflow management in dogs with intervertebral disk extrusion and ischemic myelopathy cranial to the L3 spinal cord segment: 61 dogs (2018-2022).

To describe the application and owner experience of tube cystostomy for management of upper motor neuron urinary bladder dysfunction secondary to intervertebral disk extrusion (IVDE) or ischemic myelopathy, and to report complications associated with cystostomy tube management. 61 dogs. Medical records of dogs with IVDE or ischemic myelopathy cranial to the L3 spinal cord segment that underwent tube cystostomy placement via a short, caudal ventral midline celiotomy were reviewed. Days from tube placement to hospital discharge, days from placement to tube removal, and complications were recorded. An owner questionnaire was distributed to ascertain ease of use and perceived time commitment. 58 dogs were diagnosed with IVDE, and 3 dogs were diagnosed with ischemic myelopathy. The modal neurologic grade at cystostomy tube placement was 4 (range, 3 to 5). The median number of days from cystostomy tube placement to hospital discharge was 1 (range, 0 to 3). Follow-up data was available for 56 dogs. The median number of days from cystostomy tube placement until removal was 19 (range, 3 to 74). Fifteen minor and 6 severe postoperative complications were reported, mainly inadvertent removal (n = 11) and peristomal urine leakage (6). Twenty-seven owners responded to the questionnaire and primarily reported that cystostomy tube use was easy (22/27) and perceived time commitment was low or minimal (20/27). Tube cystostomy facilitates early hospital discharge and allows at-home, extended urinary management in dogs recovering from upper motor neuron urinary bladder dysfunction secondary to IVDE or ischemic myelopathy. This technique is simple for owners to use.

Management of urolithiasis in calves by tube cystostomy

Management of urolithiasis in calves by tube cystostomy

High urinary trace element concentrations: A possible indicator of urolithiasis in goats?

BackgroundUrolithiasis is a common urinary tract disorder among male goats. The role of trace elements in the crystallization of supersaturated urine has garnered considerable interest in other species, whereas their role in urolithogenesis has not been studied so far in goats. This study investigated the possible roles of urinary trace elements (Mn, Fe, Cu, and Zn) in the pathogenesis of urolithiasis in goats. Materials and methodsEight male goats with obstructive urolithiasis were used in the study. A celiotomy with tube cystostomy was performed after the diagnosis. Urine samples collected intra-operatively were used for physico-chemical examination, microscopy, and trace element quantification by atomic absorption spectroscopy. Urinary sediments were also used for chemical functional group determination by Fourier-transform infrared (FTIR) spectroscopy. ResultsMultiple coffin-top-shaped urinary crystals were observed in all the goats. Mean urinary Mn, Fe, and Zn concentrations were significantly (P < 0.05) higher in urolithic goats than in healthy controls. The mean urinary Cu concentration was found to be non-significantly higher in urolithic goats than in healthy controls. FTIR spectroscopy confirmed the presence of PO43−, NH4+, and OH− chemical functional groups in the selected urinary sediments. ConclusionsThe findings suggest that high urinary Mn, Fe, Cu, and Zn concentrations in goats play a role in the urolithogenesis of phosphate stones.

Tube cystostomy for management of uroperitoneum (water belly) in a weaned Brahma bull-calf

Objective: This study highlights a case of uroperitoneum from urinary bladder rupture in a bovine calf and further describes the surgical interventions. Materials and Methods: A 7-month-old weaned Brahma bull-calf was presented with a distended abdomen alongside a history of complete absence of urination for 9 days. Previously, the animal suffered from urinary inconsistence and dribbling-type urination. Physical palpation on the ventral aspect of the distended abdomen revealed a fluid-filled condition, and further needle aspiration confirmed the fluid to have a slightly alkaline pH resembling that of urine. The preputial manipulation and urinary catheterization were of no use for the obstruction. A light uremic smell was found in the animal’s breathing. Elevated blood urea nitrogen and creatinine were also detected. Clinically, it was assumed to be a ruptured urinary bladder (cystorrhexis) and subsequently diagnosed as a case of uroperitoneum (water belly). Paramedian laparotomic exploration was carried out to detect the ruptured part (perforation) of the bladder, and simultaneous expulsion of the accumulated peritoneal urine was done. A tube cystostomy was performed with Foley’s catheter to handle the case after repairing the perforated bladder (cystorrhaphy). In the postoperative phase, supportive medications and good management were ensured. Results: The calf recovered within 2 weeks of surgery and was found to maintain unremitting urine flow through the surgically fixed catheter. However, the calf was culled after 1 month of surgery. Conclusions: Tube cystostomy can be an effective approach for the management of water bellies in calves to save lives.

Reconstruction of convex urethral stoma in a cat with prepubic urethrostomy.

An intact, male mixed-breed cat approximately 3 months of age was referred to Iwate University Veterinary Teaching Hospital with dysuria that developed after a traffic accident. At the initial visit, a cystostomy tube was placed as a temporal urinary diversion. Antegrade urethrography revealed severe stenosis of the intrapelvic urethra. A prepubic urethrostomy (PPU) with formation of a convex urethral stoma was performed 22 days after the first visit. Twenty-four months after surgery, the cat could urinate smoothly in a standing position, although a small amount of intermittent leakage was observed immediately after getting up. There was no evidence of peristomal dermatitis. Therefore, the formation of a convex urethral stoma may effectively prevent peristomal dermatitis in cats who undergo PPU.

Occurrence of Urolithiasis and Its Surgical Management in Goats

The objective of the study was to determine the occurrence and find a suitable surgical method of urolithiasis in goat. To achieve this objective, a retrospective study was conducted to observe the occurrence of urolithiasis in goats at Veterinary Teaching Hospital of Bangladesh Agricultural University in Bangladesh from 2011 to 2020. During this period, 265 cases of urinary obstruction were recorded out of 3237 surgical cases, where 169 cases were in goats. The highest cases of urolithiasis in goat were recorded in the summer season (76 cases 45%), followed by in the winter season (59 cases, 35%) and in the rainy season (34 cases, 20%). Among the affected goats, 42 (25%) patients were between 0 to 3 months old, (88, 52%) patients were between 3 to 8 months old and (39, 23%) patients were over 8 months old. Gender variation was seen where males were mostly affected. Goats castrated at an early age were more affected. From January 2011 to June 2020, 36 goats were treated by the procedure of tube cystostomy. Among them, 28 (78%) goats recovered successfully but 8 (22%) goats did not recover due to farmer’s improper management. This study should be helpul for the veterinarian to aware about the occurrence of urolithiasis, and proper surgical management through the tube cystostomy to save economic losses of the goat farmers. Ann. Bangladesh Agric. (2021) 25 (2) : 1-12

Prepubic urethrostomy in a Wiesenauer minipig with urolithiasis

A 10-year-old castrated, male miniature pig was presented with tenesmus vesicae and anuria accompanied by tachypnea. Radiographs confirmed numerous uroliths within the bladder and urethra. The urethra was not amenable to catheterization, therefore, an emergency tube cystostomy was performed. Despite bladder irrigation the uroliths in the urethra were not removable. Consequently, a prepubic urethrostoma procedure was undertaken. The minipig fully recovered and has since been voiding urine via the urethral fistula uneventfully. Measures to prevent urolithiasis, among others, include an adequate water intake, a balanced feed and diet composition as well as maintaining a physiological urine pH.

Small ruminant urinary obstruction: decision trees for treatment.

Urolithiasis is the most common cause of urinary tract disease in small ruminants and has significant economic and production impacts worldwide. Urolithiasis is multifactorial in origin and generally begins with the formation of cystoliths followed by urethral obstruction. The condition is most common in males. Clinical signs are variable depending on the severity of the obstruction. Uroliths can be calcium, struvite, or silicate based; however, struvite and amorphous magnesium calcium phosphate are the most common urolith types observed in small ruminants. Although urethral process (vermiform appendage) amputation is widely considered the first line of treatment, reobstruction is common within the first 36 hours. Surgical interventions such as temporary tube cystostomy, perineal urethrostomy (PU), modified proximal perineal urethrostomy, vesico-preputial anastomosis (VPA), and urinary bladder marsupialization (BM) are reported to carry an improved prognosis for long-term survival. PU carries a lower proportion of long-term success (> 12-month survival time) when compared with VPA and BM. Stoma stricture and urine scald are the most commonly observed surgical complications. Currently, the literature provides minimal direction for clinician decision-making in managing these cases while accounting for patient history, client financial ability, composition of calculi, and potential treatment complications. Small ruminant urinary obstructions are challenging and complicated conditions to treat, due to their multifactorial etiology, ruminant urogenital anatomy, and the variety of imperfect treatment options available. The purpose of this article this article is to provide veterinary practitioners with decision trees to guide management and treatment of urolithiasis in small ruminants.

Proactive discontinuation of postoperative antibiotic prophylaxis after urethroplasty.

We aimed to examine the clinical significance of an antimicrobial administration protocol, in which postoperative prophylaxis was proactively discontinued. We included 81 adult urethroplasties performed at our institution in the study. Preoperative bacteriuria was treated using an appropriate antimicrobial agent 2-5 days before surgery. All patients were treated with intravenous antimicrobial agents until postoperative day 2, and thereafter without prophylaxis. Antibiotics were resumed from the day before the urethrogram for urethral catheter removal, 2-3 weeks postoperatively. The relationships between pre- and postoperative positive urine culture and postoperative infectious complications, along with factors influencing surgical success rate were examined retrospectively. Of the 81 patients, 60 underwent anastomotic repair and 21 underwent substitution repair. Positive preoperative urine cultures were more frequent in patients having suprapubic cystostomy tube than in those without (P < 0.0001), but such a difference was not noted postoperatively between the two groups, and approximately half of the patients had a positive urine culture postoperatively. Wound infections and symptomatic urinary tract infections rates were 3.7% and 2.5%, respectively, similar to previous studies with longer prophylaxis, and no significant correlation was noted with pre- and postoperative positive urine culture, treated by this antibiotic protocol. The overall clinical and objective success rates were 96.3% and 79.0%, respectively, and no significant impact of pre- or postoperative positive urine culture was noted. The only significant parameter for objective success was patient age. Perioperative management of urethroplasty is feasible using the antimicrobial protocol described in this study.

Tube cystostomy in clinical cases of urethral obstruction in bullocks: Difficult but possible to increase the rate of success

Tube cystostomy in clinical cases of urethral obstruction in bullocks: Difficult but possible to increase the rate of success

Management of urolithiasis in male Kankrej bovines

The study included 30 male Kankrej bovines showing symptoms of urinary obstruction. All the animals were clinically examined for the colour of conjunctival mucous membrane, capillary refill time, fluid thrill and distension of abdomen, and evaluated ultrasonographically. Ultrasonographic examination (transabdominal and trans-rectal) provided quick and definitive information about the status of urinary bladder. Surgical treatment was done in 17 bovines; post-scrotal urethrotomy in 9 bullocks, and tube cystostomy in 8 calves. Surgical intervention, urethrotomy or tube cystotomy, along with oral feeding of ammonium chloride yielded good results.

Comparison of two different methods of establishment of canine urethroplasty model: an experimental trial

BackgroundGraft substitute urethroplasty is recommended for patients with long segment anterior urethral stricture. The therapeutic effects of the grafts need to be validated on the animal models. Therefore the aim of this study was to compared the operative time, blood loss, intra- and post- operative complications of two different methods of establishment of canine urethroplasty model.MethodsTwelve Beagle dogs were randomly separated into control and experimental group using a random number table. Six animals in the control group received the conventional urethroplasty, while the other 6 in the experimental group received the modified procedures. Tube cystostomy and urethroplasty were performed in the control group. The cystostomy not the tube cystostomy were performed in the experimental group, and the testes were simultaneously removed with the scrotum. Per- and postoperative outcomes, complications were evaluated.ResultsThe urethroplasty were successfully performed for all dogs and all of these procedures were done by the same surgeon. The median operative time in the control and experimental groups was 186.8 min and 188.7 min respectively. The blood loss in the control and experimental groups was 40.8 ml and 45.8 ml respectively. No intraoperative complications occurred. 3 animals in the control group developed acute urinary retention after the accidental removal of suprapubic bladder tube and the cystostomy was done again. There was no occurrence of urinary retention in the experimental group. 4 animals in the control group developed the perineal hematoma, in which one animal had the urine leakage and incision infection. Perineal hematoma occurred in only one animal in the experimental group.ConclusionThe occurrence of urinary retention and perineal hematoma decreased in the modified group, in which the cystostomy not the tube cystostomy were performed and the testes with the scrotum were simultaneously removed.

Percutaneous Balloon-Assisted Suprapubic Cystostomy Tube Placement: A Novel Technique.

Percutaneous Balloon-Assisted Suprapubic Cystostomy Tube Placement: A Novel Technique.

Участие Р2-рецепторов в сократительной активности мочевого пузыря пациентов с доброкачественной гиперплазией предстательной железы

AIM to study the role of P2 receptors in impaired bladder contractility in patients with lower urinary tract obstruction. MATERIALS AND METHODS in pharmacological studies, tissue samples from the bladder wall of 30 patients were used, obtained during planned surgical interventions for benign prostatic hyperplasia (transvesical simple prostatectomy without placement of cystostomy tube). Based on these tissue, isolated smooth muscle specimens were prepared. Their mechanical activity and the efficiency of ligands of purine P2 and other receptors were evaluated. With this aim, the following P2-receptor agonists were used: adenosine triphosphoric acid (ATP), adenosine diphosphoric acid (ADP), uridine-5'-triphosphoric acid (UTP), alpha, beta-methylene-ATP, 2-methylthio-ADP, as well as antagonists of P2-disulfonate receptors acid (PPADS), suramin, NF023, MRS2500. In addition, the efficiency of ligands of other receptors, including carbacholine, epinephrine, histamine, serotonin, atropine was evaluated. RESULTS the most effective agonist was alpha-beta-methylene-ATP, while ATP and 2-methylthio-ADP were significantly less active. In our experiments, ADP and UTP did not show an effect on human bladder. The influence of P2 receptor agonists was inhibited by P2 receptor antagonists PPADS and suramin, as well as MRS2500, although to a lesser extent. Carbacholine caused a strong concentration-dependent contractile response of the bladder, which was inhibited by atropine. Histamine resulted in mild bladder contractions only at high concentrations. Epinephrine and serotonin did not cause significant changes in the contractile activity of the bladder. CONCLUSION The main subtype of P2 receptors involved in the contractile activity of the human bladder is P2X1 receptors. P2Y1 receptors also have some influence on the contraction, while other subtypes of P2 receptors are not detected by pharmacological methods.