Page 552 - WSAVA2018
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 25-28 September, 2018 | Singapore
Laboratory findings: Results of a complete blood
count and serum chemistry profile are generally normal in patients presenting acutely; urinalysis may show evidence of urinary tract infection and and/or crystalluria. Patients presenting after several days of complete obstruction may have significant changes in their biochemical profile including increased BUN, increased creatinine, metabolic acidosis, and severe electrolyte abnormalities. Urine is generally grossly hemorrhagic and urinalysis may show signs of urinary tract infection and crystaluria.
Radiography: Survey radiographs may show presence of radiodense calculi in the urethra and/or urinary bladder as well as a distended urinary bladder. Occasionally, radiolucent calculi occur and can only be visualized using retrograde contrast cystourethrography. Careful radiographic evaluation of the kidneys and ureters should be done to rule out renal and ureteral calculi.
Ultrasonographic examination of the bladder, ureters, and kidneys may be helpful in diagnosis of cystic, ureteral, or renal calculi.
Differential diagnosis: Any disorder causing urinary obstruction, including urethral neoplasia, granulomatous urethritis, urethral stricture, and urethral trauma. Definitive diagnosis is based on clinical signs, inability to pass a catheter, and evidence of calculi on survey or contrast radiographs.
MEDICAL MANAGEMENT:
Immediate care: In animals with complete obstruction long enough to cause azotemia, temporary urinary diversion is provided by performing a prepubic cystostomy (see technique described below) or frequent cystocentesis (i.e, tid to qid). Azotemia is treated with crystalloid IV therapy prior to calculus removal.
Urethral catheterization of a female cat:
Female urethral catheterization is easier than male
Use a closed ended tom cat catheter
Ventral recumbancy is recommended
Pass the catheter with no evidence of resistance
RETROGRADE HYDROPULSION OF LODGED URETHRAL CALCULI
Calculus removal: Retrograde hydropulsion: This technique should result in an 80-85% success rate for retropulsing urethral calculi into the urinary bladder!
Thoroughly mix 20 cc of sterile saline and 5 cc of Surgilube or K-Y Jelly in a 35 cc syringe and attach the syringe to a 3.5 - 5.0 French soft rubber catheter/feeding tube.
Anesthetize the patient, extrude the penis and pass the lubricated urinary catheter in the urethra up to and
against the calculus. Place a dry gauze sponge around the extruded tip of the penis and occlude the penis around the catheter by squeezing it with thumb and finger.
Using a back and forth action on the catheter, simultaneously inject the saline/lubricant mix under extreme pressure.
a) During injection, the calculi and urethra are lubricated by the saline/lubricant mix while the viscosity of the mixture (i.e., KY jelly and saline) encourages the calculus to dislodge and become retropulsed into the urinary bladder.
b) This technique is attempted, and generally successful, regardless of how many stones are in the urethra and no matter where they are lodged.
If the above technique fails, use a stiffer catheter (i.e., open or closed ended tomcat catheter) and repeat the above maneuvers. Use care when manipulating these stiffer catheters against the calculus.
SURGICAL TREATMENT:
The objective of surgical treatment is to remove all retropulsed calculi from the urinary bladder and any remaining urethral calculi that were unable to be retropulsed. Bladder calculi are removed via cystotomy, urethral calculi are removed via urethrotomy, and patients that are frequent stone formers may benefit form a permanent urethrostomy to allow continual passage of small urethral calculi.
Preoperative management: Patients that present acutely can be anesthetized immediately and retropulsion attempted (see above described technique). If urinary tract infection is suspected, preoperative treatment with antibiotics may be instituted.
Patients that present after several days of complete obstruction should be treated medically until the azotemia resolves, blood gas abnormalities resolve,
and electrolytes return to normal. The patients’ electrocardiogram should be monitored if hyperkalemia is present preoperatively. Medical treatment may consist of intravenous fluids, systemic antibiotics, continuous ECG monitoring, and bladder decompression. Bladder decompression may be accomplished via multiple cystocentesis (i.e., tid or qid), or placement of an antepubic cystostomy tube (described in detail below).
Anesthesia: Routine general anesthesia is performed in patients that present acutely without signs of azotemia. Azotemic, shocky patients with moderate to severe biochemical abnormalities should be treated as described above until these abnormalities return to normal.
Surgical anatomy: The male feline penile urethra consists of urethral mucosa (i.e., urothelium) surrounded
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43RD WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND 9TH FASAVA CONGRESS




































































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