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Shipov A, Israeli I, Billet JP, Adam Y, Milgram J. Effect of Perineal Urethrostomy on the Length of the Urethra of the Cat: A Cadaveric Study. Animals (Basel) 2023; 13:2810. [PMID: 37760210 PMCID: PMC10525431 DOI: 10.3390/ani13182810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Perineal urethrostomy in cats is indicated for urethral pathologies located distal to the bulbourethral glands. The description of the bulbourethral glands as the cranial landmark when performing a PU is based on the increased urethral diameter at this location, rather than on an anatomical limitation. This suggests that urethral pathologies cranial to the bulbourethral glands could potentially be treated with PU. At present, the extent to which the pelvic urethra can be mobilized is unknown. Characterization and quantification of the effect of PU on the pelvic urethra is required prior to attempting to define the location of the pelvic urethra, cranial to the bulbourethral glands, which can be exteriorized when performing a PU. Our aim was to characterize and quantify the effect of performing a PU on the location and length of the pelvic urethra. METHODS Ten male feline cadavers were used, and four markers were placed on the pelvic urethra via a ventral approach to the peritoneal and pelvic cavities. Two orthogonal radiographic views were acquired prior and subsequent to performing a PU. The distance of each marker to a predefined landmark/origin and the distances of the markers relative to each other were measured on all radiographs. RESULTS PU resulted in significant caudal translation of the markers relative to the predefined landmark on all radiographic views; however, PU did not result in a significant change in the distances between the markers. CONCLUSIONS Performing a PU results in caudal translation and minimal stretching of the mobilized pelvic urethra.
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Affiliation(s)
- Anna Shipov
- Veterinary Teaching Hospital-Koret School of Veterinary Medicine, Faculty of Agriculture Food & Environment, Hebrew University Jerusalem, Rehovot 7610001, Israel; (A.S.)
| | - Inbar Israeli
- Freelance Surgery, Tel Aviv 5800001, Israel
- Freelance Surgery, New York, NY 14925, USA
| | | | - Yoav Adam
- Veterinary Teaching Hospital-Koret School of Veterinary Medicine, Faculty of Agriculture Food & Environment, Hebrew University Jerusalem, Rehovot 7610001, Israel; (A.S.)
| | - Joshua Milgram
- Veterinary Teaching Hospital-Koret School of Veterinary Medicine, Faculty of Agriculture Food & Environment, Hebrew University Jerusalem, Rehovot 7610001, Israel; (A.S.)
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David S, Minnoye S, de Rooster H, Stock E, Devriendt N. Comparison of urethral length and orifice diameter in cats undergoing transpelvic or subpubic urethrostomy for perineal urethrostomy revision (cadaveric study). J Feline Med Surg 2023; 25:1098612X221137076. [PMID: 36638151 PMCID: PMC10812044 DOI: 10.1177/1098612x221137076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Stenosis is a postoperative complication reported in 12-17% of male cats that undergo perineal urethrostomy (PU). This study compared two different revision techniques for failed perineal urethrostomies. The first objective was to evaluate the feasibility of performing a transpelvic urethrostomy (TPU) after a previous, correctly performed PU in male cats. The second objective was to determine the residual urethral length, orifice diameter, and the position of the orifice relative to the pubic brim and anus after PU, TPU and subpubic urethrostomy (SPU). METHODS Twenty male cat cadavers were randomly divided into two groups: TPU and SPU. In group TPU, PU was followed by TPU; in group SPU, PU was followed by SPU. After each procedure, the urethral orifice cross-section size was estimated by inserting the largest possible urinary catheter without resistance. Residual urethral length was measured both on contrast radiographs and after anatomical dissection. RESULTS In all cats, TPU could be performed following a technically correct PU. The TPU resulted in a 1.5-times longer residual urethral length than SPU, based on contrast radiographs (P = 0.001) and confirmed by anatomical dissection (P <0.001). Relative to the initial urethral length, PU, TPU and SPU resulted in a reduction of 24%, 36% and 56%, respectively. The urethral orifice diameter after TPU did not differ from SPU (P = 1.000), and it was not statistically significantly different between TPU and PU (P = 0.317) or between SPU and PU (P = 0.655). The urethral orifice was located further away from the pubis (P <0.001) and closer to the anus (P <0.001) after TPU than after SPU. CONCLUSIONS AND RELEVANCE Both TPU and SPU are possible revision surgeries following PU. As TPU preserves a significantly longer urethral length and requires less tissue dissection, the risk of urinary tract infections, urinary dermatitis and urinary incontinence might be less following TPU than SPU.
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Affiliation(s)
- Sieglinde David
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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He C, Fan K, Hao Z, Tang N, Li G, Wang S. Prevalence, Risk Factors, Pathophysiology, Potential Biomarkers and Management of Feline Idiopathic Cystitis: An Update Review. Front Vet Sci 2022; 9:900847. [PMID: 35812890 PMCID: PMC9257190 DOI: 10.3389/fvets.2022.900847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Feline idiopathic cystitis is a widespread disease in small animal clinics, which mainly presents with urinary signs like dysuria, stranguria, hematuria, pollakiuria, and periuria. The etiopathogenesis of the disease may involve interactions between the environmental stressors, neuroendocrine system and bladder of affected cats. Diagnostic biomarkers have not been tested in clinical studies though they are theoretically feasible, and since the clinical signs of the disease assemble those of other feline lower urinary diseases, its diagnosis is a procedure of exclusion. The primary treatment of the disease is long-term multimodal environmental modification (or enrichment) while anti-anxiety drugs and nutritional supplements are recommended for chronic recurrent cases. Still, many medicines need to be evaluated for their efficacy and safety. This review aims to provide readers with a comprehensive understanding of feline idiopathic cystitis by summarizing and updating studies concerning the prevalence, risk factors, etiological hypotheses, diagnostic procedures, possible treatments, and prognosis of the disease.
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Vitello G, Bacon J, Earley NF. Ultrasound diagnosis and medical management of presumed segmental ureteritis in a cat. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bresciani L, Mosca A, Romussi S. Modified prepubic urethrostomy with body wall tunneling: Description of technique and long-term outcome in eight male cats. Vet Surg 2021; 51:353-360. [PMID: 34850408 DOI: 10.1111/vsu.13747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/26/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the procedure, complications, and long-term outcome of cats that underwent a modified prepubic urethrostomy (mPPU) technique for the management of proximal urethral obstructions. ANIMALS Eight male cats. STUDY DESIGN Short case series. METHODS Medical records were reviewed for signalment, diagnostic investigation, details of the surgical procedure, and complications of cats that underwent mPPU. RESULTS mPPU was well tolerated by all patients, and no intraoperative complications were reported. The duration of follow-up ranged from 13 to 84 months (median 19 months). Early postoperative skin scalding around the stoma associated with mild urinary incontinence during recumbency occurred and was self-limiting in all patients. Two cats required surgical revision at 5 and 6 months, respectively, due to a progressive weight gain and accumulation of abdominal fat around the stoma, causing a partial stomal obstruction. Resolution of clinical signs was reported in both patients. CONCLUSIONS mPPU was easy to perform and offered favorable outcomes in this cohort of cats.
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Affiliation(s)
- Luca Bresciani
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Andrea Mosca
- Langford Vets, University of Bristol, Bristol, UK
| | - Stefano Romussi
- Department of Veterinary Medicine, University of Milan, Milan, Italy
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Dumartinet C, Bernard F, Bernardé A. Outcomes and postoperative complications after transpelvic urethrostomy used as first-line surgery in 38 male cats with obstructive lower urinary tract disease. J Feline Med Surg 2021; 24:558-564. [PMID: 34431736 DOI: 10.1177/1098612x211038529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This article aimed to report on the short- and long-term outcomes after transpelvic urethrostomy (TPU) as a first-line surgery to treat obstructive lower urinary tract disease (OLUTD) in male cats. METHODS A retrospective review and follow-up owner telephone questionnaire for cats with OLUTD undergoing TPU as a first-line surgery between 2013 and 2019, at a single referral hospital, were performed. A minimum follow-up period of 1 year was required to be included in the study. Short- and long-term complications were defined as those that occurred, respectively, within or after the first 4 weeks postoperatively. RESULTS Thirty-eight male cats were included. The short-term complication rate was 18%. Idiopathic lower urinary tract disease (ILUTD) and stomal stenosis (SS) were the two most frequent short-term complications. Long-term complications were reported in 34% of the cats and included ILUTD, urinary tract infection and SS. The mortality rate was 5%. Eighty-two percent of the owners were satisfied with the postoperative outcome. The most common reason for owner dissatisfaction was the occurrence of SS, especially because these complications required multiple surgical revisions to be definitively managed. The long-term quality of life was considered to be good to very good by 89% of the owners. Ninety-one percent of the cats were free of clinical urinary signs at the time of the questionnaire completion. CONCLUSIONS AND RELEVANCE TPU can be an acceptable first-line surgical technique to treat cats with OLUTD. Most cats experienced a good to very good quality of life after TPU. Most complications were transient or manageable medically. Most of the major complications were SS, which can be technically challenging to address and may require multiple revision surgeries.
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Affiliation(s)
| | - Fabrice Bernard
- Centre Hospitalier Vétérinaire St Martin, St Martin, Bellevue, France
| | - Antoine Bernardé
- Centre Hospitalier Vétérinaire St Martin, St Martin, Bellevue, France
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Dickerson VM, Grimes JA, Hill TL, Bartges JW, Schmiedt CW. Management of a urethral tear with porcine small intestinal submucosa-augmented urethroplasty and balloon dilation for subsequent urethral stricture in a cat. J Am Vet Med Assoc 2021; 258:186-191. [PMID: 33405984 DOI: 10.2460/javma.258.2.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION As a result of vehicular trauma, a 3-year-old neutered male domestic shorthair cat sustained luxation of the sacrocaudal joint and a urethral tear. CLINICAL FINDINGS Retrograde contrast urethrocystography revealed a urethral tear at the level of the ischiatic tuberosity. Conservative treatment for 7 days with a urethral catheter was unsuccessful. TREATMENT AND OUTCOME An approach for a perineal urethrostomy was performed and revealed a large urethral tear (4 mm in length in a craniocaudal orientation and encompassing approx 50% of the urethral circumference) proximal to the bulbourethral glands. Urethroplasty was performed with a graft of a rectangular section of single-layer porcine small intestinal submucosa. Perineal urethrostomy was then completed routinely, and a urethral catheter was left in place for 5 days. Two days after removal of the urethral catheter, stranguria was noted. Retrograde contrast urethrocystography revealed a urethral stricture. Balloon dilation of the urethral stricture was performed, and the cat's stranguria improved. Ten weeks following balloon dilation, the cat developed hematuria, and a urinary tract infection and urethral stricture were diagnosed. Balloon dilation was repeated with instillation of triamcinolone solution at the stricture site. Eighteen months later (approx 21 months after the initial surgery), the cat was urinating normally. CLINICAL RELEVANCE The outcome for the cat of this report indicated that porcine small intestinal submucosa may be used to successfully augment urethroplasty for treatment of traumatic urethral tears in cats. Urethral balloon dilation with triamcinolone instillation may be used to treat postoperative urethral strictures.
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Seneviratne M, Stamenova P, Lee K. Comparison of surgical indications and short- and long-term complications in 56 cats undergoing perineal, transpelvic or prepubic urethrostomy. J Feline Med Surg 2020; 23:477-486. [PMID: 32996836 DOI: 10.1177/1098612x20959032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to compare indications, complications and mortality rates for perineal urethrostomy (PU), transpelvic urethrostomy (TPU) and prepubic urethrostomy (PPU). METHODS A retrospective review of, and follow-up owner questionnaire for, cats undergoing urethrostomy between 2008 and 2018, at a single referral hospital, were performed. RESULTS 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. CONCLUSIONS AND RELEVANCE 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.
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Affiliation(s)
- Maheeka Seneviratne
- Department of Clinical Science and Services, Royal Veterinary College, London, UK
| | - Polina Stamenova
- Department of Clinical Science and Services, Royal Veterinary College, London, UK
| | - Karla Lee
- Department of Clinical Science and Services, Royal Veterinary College, London, UK
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Sousa-Filho RP, Nunes-Pinheiro DC, Sampaio KO, da Silva EC, Cavalcanti GA, Mori da Cunha MGM. Clinical outcomes of 28 cats 12-24 months after urethrostomy. J Feline Med Surg 2019; 22:890-897. [PMID: 31808718 DOI: 10.1177/1098612x19888808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate and compare the long-term clinical outcomes and quality of life of cats having undergone perineal urethrostomy (PU) or prepubic urethrostomy (PPU). METHODS This clinical study followed 28 cats (PU, n = 22; PPU, n = 6) that underwent a urethrostomy, with a minimum of 1 year postoperative follow-up. Medical records, pet owner surveys and urologic laboratory tests were used for assessment. Urologic laboratory tests included serum symmetric dimethylarginine (SDMA), serum creatinine, urinalysis, urine specific gravity (USG), urine protein:creatinine (UPC) ratio and urine culture. RESULTS The main indications for urethrostomy were multiple catheterizations and PU stricture. The overall complication rates of PU and PPU were 31.8% and 83.3%, respectively. Recurrent urinary tract infection (UTI) and urine scald dermatitis were less frequent in PU than in PPU cats (UTI 22.7% vs 66.6%; dermatitis 4.5% vs 83.3%). Bacteriuria was present in 77.2% and 100% of PU and PPU cats, respectively. Owner satisfaction rates were excellent in 81.8% of PU and 33.3% of PPU cases. CONCLUSIONS AND RELEVANCE A proportion of cats that underwent urethrostomy showed bacteriuria, recurrent UTIs and increased levels of SDMA. PPU is important as a salvage procedure; however, it should be limited to cases in which standard techniques for PU cannot be performed, owing to the potential for recurrent complications and lower owner satisfaction.
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Affiliation(s)
| | | | - Keytyanne O Sampaio
- Veterinary Medicine Faculty, Federal Rural University of Pernambuco, Recife, Brazil
| | - Ellen Cb da Silva
- Veterinary Medicine Faculty, Federal Rural University of Pernambuco, Recife, Brazil
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Slater MR, Pailler S, Gayle JM, Cohen I, Galloway EL, Frank KA, DeClementi C. Welfare of cats 5-29 months after perineal urethrostomy: 74 cases (2015-2017). J Feline Med Surg 2019; 22:582-588. [PMID: 31422742 DOI: 10.1177/1098612x19867777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the long-term quality of life in cats following perineal urethrostomy. METHODS This study comprised a retrospective case series of 74 cats with urinary obstructions that received perineal urethrostomies at the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital between September 2015 and July 2017. Medical records were reviewed for information on the number of obstructions prior to surgery, urinary tract problems at the time of surgery and other potential factors influencing long-term welfare. Owners were surveyed by telephone and text 5-29 months after their cat's surgery. Responses were compiled and analyzed to determine owner perception of welfare postsurgery, and to identify patterns in medical history and welfare outcomes. RESULTS In total, 105 cat owners were eligible for the survey; 74 responded. Altogether, 100% of responding individuals reported at least the same quality of life postsurgery compared with the cat's quality of life before demonstrating urinary problems (48% reported better). On a quality-of-life scale of 1-10 (10 = excellent), 100% of responding cat owners reported at least 7; 75% reported 10. CONCLUSIONS AND RELEVANCE Quality-of-life outcomes for cats 5-29 months after receiving perineal urethrostomy surgery were reported to be very good. Given this finding, and that perineal urethrostomy surgery should mitigate future blockages, we suggest considering perineal urethrostomy surgery as a standard tool to manage urinary obstructions in cats. The needs of the specific client and patient, including risks, costs and welfare of the cats, should drive the options for management of urinary obstructions in male cats.
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Affiliation(s)
- Margaret R Slater
- American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital, New York City, NY, USA
| | - Sharon Pailler
- American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital, New York City, NY, USA
| | - J'mai M Gayle
- American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital, New York City, NY, USA
| | - Illoneete Cohen
- American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital, New York City, NY, USA
| | - Erin L Galloway
- American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital, New York City, NY, USA
| | - Kristen A Frank
- American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital, New York City, NY, USA
| | - Camille DeClementi
- American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Hospital, New York City, NY, USA
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Watson MT, Roca RY, Breiteneicher AH, Kalis RH. Evaluation of postoperative complication rates in cats undergoing perineal urethrostomy performed in dorsal recumbency. J Feline Med Surg 2019; 22:399-403. [PMID: 30912694 DOI: 10.1177/1098612x19838286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
CASE SERIES SUMMARY Medical records were reviewed for cats that underwent a perineal urethrostomy performed in dorsal recumbency for the treatment of urethral obstruction. Information, including signalment, reason for presentation, number of previous obstructions, surgery time, and perioperative and postoperative complications, were collected through a review of medical records and owner follow-up. The objective was to evaluate short- and long-term complications in cats that underwent perineal urethrostomy performed in dorsal recumbency for treatment of urethral obstruction. RELEVANCE AND NOVEL INFORMATION No major or life-threatening complications, such as urethral stricture, re-obstruction, euthanasia due to lower urinary signs or chronic urinary tract infection, were reported. Short-term complications were limited to dysuria in 2/12 (16.7%) cats. Long-term follow-up was available for nine cats. The most common long-term complication seen in this population of cats was a single recurrence of urinary tract infection in 3/9 (33.3%) cats that resolved after a short course of empirical antibiotic therapy. Performing perineal urethrostomy in dorsal recumbency is safe and may have advantages to ventral recumbency due to improved visualization, allowing for more efficient dissection and improved accuracy in tissue apposition during closure. We believe this has been a major contributor to our reported reduced major postoperative complication rate.
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Affiliation(s)
- Mallory T Watson
- Surgery Department, Austin Veterinary Emergency & Specialty Center, Austin, TX, USA
| | - Rodrigo Y Roca
- Surgery Department, Austin Veterinary Emergency & Specialty Center, Austin, TX, USA
| | - Adam H Breiteneicher
- Surgery Department, Austin Veterinary Emergency & Specialty Center, Austin, TX, USA
| | - Russell H Kalis
- Surgery Department, Austin Veterinary Emergency & Specialty Center, Austin, TX, USA
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