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Surgical Case Study - Canine Urethral Obstruction

By Jeff Stallings, DVM, DACVS
Winter 2016
CASE STUDY: "Maxwell"




Patient Name: Maxwell

Age: 15-year-old MN Pug Mix

Referred by: Dr. Jill Partlow, Pet Care Veterinary Hospital

History:  Maxwell is a 15-year-old neutered male Pug mix that was referred to The COVE emergency room by his primary care DVM for stranguria and a partial urethral obstruction. Maxwell presented for routine examination and the owner stated that he had inappropriately urinated in the house, which was out of character for him. A free catch urinalysis was performed, and a significant UTI was noted. Abdominal radiographs revealed multiple large urethroliths. A referral for hospitalization, stabilization, and surgical consultation was recommended. 
 
Presentation:  Upon presentation to The COVE, Maxwell was QAR.
  • Weight: 8.8 lbs/4.0 kg (BCS 4/9)
  • Temp: 101.7; mm- pink/mildly tacky
  • CRT: <2 sec
  • Heart Rate: 132 BPM (Grade III/VI heart murmur ausculted)
  • Respiratory Rate: 54 BPM; clear breath sounds
  • Severe periodontal disease and bilateral cataracts 
  • Multiple stones were easily palpated within the distal and perineal urethra  
Diagnostics and Labwork: A pre-anesthetic cardiology consultation with Merrilee Small, DVM, DACVIM (Cardiology) was recommended.  An echocardiogram, electrocardiogram, thoracic radiographs, and blood pressure check were performed. Maxwell was diagnosed with well-compensated mitral and tricuspid valve endocardiosis. The abdominal radiographs were sent to the NCSU-CVM soft tissue team for an online consult. They advised surgical intervention to include a perineal urethrotomy, a distal urethrotomy, and scrotal urethrostomy to prevent future obstructions. The risks of these surgeries were discussed with the client and she elected to proceed .
 

Maxwell on presentation


All stones retropulsed back into the bladder


Maxwell post-op

Surgery: A routine cystotomy was performed. Thickened bladder wall was noted and all stones in bladder were removed. The urethra was flushed repeatedly in both directions until it was confirmed that all calculi had been removed. After thorough lavage, closure was accomplished routinely in multiple layers.
 
Outcome: A stone was submitted for analysis and was found to be calcium oxalate. Maxwell had a smooth recovery, and was seen two weeks later for his staple removal. He continues to do well at home and has had no complications.
 
Discussion: Benefits of retropulsion of urethral calculi into bladder prior to cystotomy:
  • Simplifies management of urethral calculi
  • May be possible to perform without anesthesia, extending time to allow for stabilization prior to anethesia
  • Decreases risk of sepsis
  • Decreases number of incisions as well as surgical time
Tech Tip
By Brandy S., LVT & Tyler G., LVT
Did You Know?
COVE News
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Gabapentin for Peri-Operative Analgesia

Gabapentin has been an overlooked medication for pre-operative and acute pain management until recently. Studies in humans have demonstrated Gabapentin to be very effective for acute and pre-operative pain.  This has been replicated in cats and dogs.  Additionally, it has been shown to be an effective anti-anxiety medication in our canine and feline patients.  When given pre-operatively at 10-20 mg/kg PO prior to induction, a reduction in pain response, anxiety as well as a reduction of other injectable analgesic and anesthesia agents is possible. The higher end dose of 20mg/kg may be continued orally [q 8 hours] post-operatively to address anxiety in addition to pain in both the cat and dog. This will provide your patients a positive, low stress experience at your hospital.
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References:
 
Grover V K, Mathew P J, Yaddanapudi S, Sehgal S. A single dose of preoperative gabapentin for pain reduction and requirement of morphine after total mastectomy and axillary dissection: Randomized placebo-controlled double-blind trial. J Postgrad Med 2009;55:257-60

Lorenz ND, Comerford EJ, Iff I. Long-term use of gabapentin for musculoskeletal disease and trauma in three cats.
J Feline Med Surg . 2012;15(6):507-512.

Vollmer KO, von Hodenberg A, K├Âlle EU. Pharmacokinetics and metabolism of gabapentin in rat, dog and man. Arzneimittelforschung. 1986;36(5):830-839.
Our New Online Referral Portal Is Scheduled for Early 2017

The COVE has partnered with rVetLink to make communication with referring veterinarians easy. We value having an open and transparent relationship with you and our new portal will allow you access to your patients' records quickly and securely. More details to come!
Welcome Our New Associate Veterinarian, Dr. Alicia Thomas

Dr. Thomas received her Doctor of Veterinary Medicine from University of Tennessee in 2015. She completed a Small Animal Medicine and Surgery rotating internship at Texas A&M in June 2016.


Colonial Veterinary Conference, Dec. 1 - 4

The COVE is a proud sponsor of the 21st Colonial Veterinary Conference. The conference will be held in Willamsburg, Virginia at Fort Magruder Hotel and Conference Center. Click here for more details .
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