Gastric Dilation Volvulus

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Gastric Dilation Volvulus
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What is a Perineal Urethrostomy (PU) in Cats?
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Situational Awareness
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This procedure is a life saving surgery. Cats do not need to die because they have obstructed, again. Unfortunately, the PU has a bit of a bad reputation; even among some board certified surgeons. It has a bad reputation because of a reported high rate of stricturing. The truth is that the most common reason why cats reblock/stricture after a PU is because the PU WAS IMPROPERLY DONE; the new opening was not created in the pelvic urethra. This procedure can be somewhat nerve wracking to perform. In order to get to the pelvic urethra you have to free up the penis and penile urethra from its attachments to the pelvis. This part can give the inexperienced surgeon trepidation (and it should). For this reason many practitioners inexperienced with the surgery will stop short of the goal and make the new opening just above the current obstruction in the penile urethra. Learning how to do this surgery from a textbook, while informative, tends not to give you the confidence that is needed. True strictures do occur and they can be difficult to deal with; these are best left for the trained surgeon. A cat with a revision surgery can still have a good outcome.
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Get Ready for Gastric Dilation Volvulus

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All the information you need.
Fully narrated surgical videos.
In depth guide and more.

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This content is designed for veterinarian professionals. If you are a pet owner, please consult your vet if you have any questions about a surgery.

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Get Ready to Perform a PU
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Preferred instrumentation for this surgery:

Straight iris scissors (sharp ones!)
Small Adson or thumn forceps
Small needle drivers
Curved mosquito hemostats (3 – 4)
4-0 or 5-0 Vicryl Rapide TM or MonocrylITM

Post-operative Considerations

Manage the cat’s pain! Otherwise they won’t urinate for 48 hours.
User an E-collar or equivalent
Avoid clay based litter (2 weeks)
Manage urolithiasis with appropriate diet
Recheck in 2 weeks, expect to see some constriction to the new stoma

The best way to be more confident when doing this procedure is to have an experienced surgeon looking over your shoulder guiding you and encouraging you. The information in this virtual workshop is the next best thing. Surgery is more than following a step-by step pictorial description.

It is important to be comfortable with the anatomy of the area. I will help you understand the relevant anatomy from a surgical perspective.
I also have a fully narrated video of me doing the surgery on a patient. When you watch the video, listen carefully to my words, I give a lot of little details, tips and tricks, that will help make the surgery easier for you. You will see how to handle the instruments and the tissues.
Watch/listen to the video several times so that when you are in surgery you will continue to hear my voice. There is no shame in playing the video while in surgery, you are trying to save a life, not impress someone with your surgical skills.

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Pre-Surgical Considerations
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When is it time to perform a PU:

The decision to recommend a PU is easy if the cat that has a non-retropulsable urethral obstruction. Clearly, if he can not be unobstructed then he should have a PU. The re-offender is the one that is of concern. How many obstructions are too many? This is a tough question to answer and requires a frank conversation with the client. It is important not to let the client run out of money before having this discussion with them! Many cats that are blocking for for the first time will be successfully managed without surgery and placed on an appropriate diet. However, close to half will block again. This might be a good time to have let them know about the surgery. Your clinical acumen can help you decide if this cat feels manageable or if he is a complicated case; however, let the client be part of the decision. What happens if he blocks a third time? Will euthanasia be a serious contender as a ‘treatment option’? Are the owners running out of money, patience and ability to cope with repeat emergency trips to the hospital? The decision to perform a PU should be based on all of these factors (emotional and financial), not just the medical ones. Your goal is to save a cat’s life!

Patient’s metabolic status:

Pre and post renal azotemia should be addressed before surgery. This is a bit of a catch-22 situation because nobody wants to push fluids into a cat that can not urinate. If the cat is severely azotemic, it is best to unblock it under heavy sedation, place an indwelling catheter and then push the fluids in. The azotemia will usually sufficiently improve by the next morning to allow for a much safer general anesthesia. If a catheter can not be placed in the urethra, then the bladder should be emptied via cystocentesis and the can then be pushed in. Clearly to be able to safely and effectively accomplish any of this, the cat will need to be in a facility with overnight care. Note that a tom cat catheter will often not reach the bladder in a cat so it is not appropriate to use as an indwelling. Consider using a red rubber catheter instead. Also, about the cystocentesis; yes the compromised bladder is at greater risk of rupturing, but know that it is not the norm; odds are it will be ok, but no guarantees. And if it does rupture, push the fluids in and clear your schedule because this cat needs surgery now. Make sure your client is aware of (but not terrified of) this risk.
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What the Clients Needs to Know
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Step by Step PU in cats
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[av_image src=’http://focusandflourish.com/wp-content/uploads/2016/06/shih-tzu-puppy-300×227.jpg’ attachment=’182′ attachment_size=’medium’ copyright=” caption=” image_size=” styling=” box_shadow=’none’ box_shadow_width=’10’ box_shadow_color=” align=’center’ font_size=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’ animation_duration=” animation_custom_bg_color=” animation_z_index_curtain=’100′ parallax_parallax=” parallax_parallax_speed=” av-desktop-parallax_parallax=” av-desktop-parallax_parallax_speed=” av-medium-parallax_parallax=” av-medium-parallax_parallax_speed=” av-small-parallax_parallax=” av-small-parallax_parallax_speed=” av-mini-parallax_parallax=” av-mini-parallax_parallax_speed=” hover=” blur_image=” grayscale_image=” fade_image=” appearance=” css_position=” css_position_location=’,,,’ css_position_z_index=” av-desktop-css_position=” av-desktop-css_position_location=’,,,’ av-desktop-css_position_z_index=” av-medium-css_position=” av-medium-css_position_location=’,,,’ av-medium-css_position_z_index=” av-small-css_position=” av-small-css_position_location=’,,,’ av-small-css_position_z_index=” av-mini-css_position=” av-mini-css_position_location=’,,,’ av-mini-css_position_z_index=” transform_perspective=” transform_rotation=’,,,’ transform_scale=’,,’ transform_skew=’,’ transform_translate=’,,’ av-desktop-transform_perspective=” av-desktop-transform_rotation=’,,,’ av-desktop-transform_scale=’,,’ av-desktop-transform_skew=’,’ av-desktop-transform_translate=’,,’ av-medium-transform_perspective=” av-medium-transform_rotation=’,,,’ av-medium-transform_scale=’,,’ av-medium-transform_skew=’,’ av-medium-transform_translate=’,,’ av-small-transform_perspective=” av-small-transform_rotation=’,,,’ av-small-transform_scale=’,,’ av-small-transform_skew=’,’ av-small-transform_translate=’,,’ av-mini-transform_perspective=” av-mini-transform_rotation=’,,,’ av-mini-transform_scale=’,,’ av-mini-transform_skew=’,’ av-mini-transform_translate=’,,’ mask_overlay=” mask_overlay_shape=’blob’ mask_overlay_size=’contain’ mask_overlay_scale=’100%’ mask_overlay_position=’center center’ mask_overlay_repeat=’no-repeat’ mask_overlay_rotate=” mask_overlay_rad_shape=’circle’ mask_overlay_rad_position=’center center’ mask_overlay_opacity1=’0′ mask_overlay_opacity2=’1′ mask_overlay_opacity3=” link=” target=” title_attr=” alt_attr=” img_scrset=” lazy_loading=’disabled’ id=” custom_class=” template_class=” av_element_hidden_in_editor=’0′ av_uid=’av-1muizjc’ sc_version=’1.0′ admin_preview_bg=”][/av_image]

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An elliptical incisions is made around the scrotum and prepuce
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[av_icon_box icon=’ue885′ font=’entypo-fontello’ title=’Step 2′ position=’left’ icon_style=’av-icon-style-no-border’ boxed=” font_color=” custom_title=” custom_content=” color=” custom_bg=” custom_font=” custom_border=” custom_title_size=’14’ av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” custom_content_size=” av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” heading_tag=” heading_class=” link=” linktarget=” linkelement=” id=” custom_class=” template_class=” av_uid=’av-1coxriw’ sc_version=’1.0′ admin_preview_bg=”]
An elliptical incisions is made around the scrotum and prepuce
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[av_image src=’http://focusandflourish.com/wp-content/uploads/2016/06/shih-tzu-puppy-300×227.jpg’ attachment=’182′ attachment_size=’medium’ copyright=” caption=” image_size=” styling=” box_shadow=’none’ box_shadow_width=’10’ box_shadow_color=” align=’center’ font_size=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’ animation_duration=” animation_custom_bg_color=” animation_z_index_curtain=’100′ parallax_parallax=” parallax_parallax_speed=” av-desktop-parallax_parallax=” av-desktop-parallax_parallax_speed=” av-medium-parallax_parallax=” av-medium-parallax_parallax_speed=” av-small-parallax_parallax=” av-small-parallax_parallax_speed=” av-mini-parallax_parallax=” av-mini-parallax_parallax_speed=” hover=” blur_image=” grayscale_image=” fade_image=” appearance=” css_position=” css_position_location=’,,,’ css_position_z_index=” av-desktop-css_position=” av-desktop-css_position_location=’,,,’ av-desktop-css_position_z_index=” av-medium-css_position=” av-medium-css_position_location=’,,,’ av-medium-css_position_z_index=” av-small-css_position=” av-small-css_position_location=’,,,’ av-small-css_position_z_index=” av-mini-css_position=” av-mini-css_position_location=’,,,’ av-mini-css_position_z_index=” transform_perspective=” transform_rotation=’,,,’ transform_scale=’,,’ transform_skew=’,’ transform_translate=’,,’ av-desktop-transform_perspective=” av-desktop-transform_rotation=’,,,’ av-desktop-transform_scale=’,,’ av-desktop-transform_skew=’,’ av-desktop-transform_translate=’,,’ av-medium-transform_perspective=” av-medium-transform_rotation=’,,,’ av-medium-transform_scale=’,,’ av-medium-transform_skew=’,’ av-medium-transform_translate=’,,’ av-small-transform_perspective=” av-small-transform_rotation=’,,,’ av-small-transform_scale=’,,’ av-small-transform_skew=’,’ av-small-transform_translate=’,,’ av-mini-transform_perspective=” av-mini-transform_rotation=’,,,’ av-mini-transform_scale=’,,’ av-mini-transform_skew=’,’ av-mini-transform_translate=’,,’ mask_overlay=” mask_overlay_shape=’blob’ mask_overlay_size=’contain’ mask_overlay_scale=’100%’ mask_overlay_position=’center center’ mask_overlay_repeat=’no-repeat’ mask_overlay_rotate=” mask_overlay_rad_shape=’circle’ mask_overlay_rad_position=’center center’ mask_overlay_opacity1=’0′ mask_overlay_opacity2=’1′ mask_overlay_opacity3=” link=” target=” title_attr=” alt_attr=” img_scrset=” lazy_loading=’disabled’ id=” custom_class=” template_class=” av_element_hidden_in_editor=’0′ av_uid=’av-1a4x09k’ sc_version=’1.0′ admin_preview_bg=”][/av_image]

[av_icon_box icon=’ue885′ font=’entypo-fontello’ title=’Step 3′ position=’left’ icon_style=’av-icon-style-no-border’ boxed=” font_color=” custom_title=” custom_content=” color=” custom_bg=” custom_font=” custom_border=” custom_title_size=’14’ av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” custom_content_size=” av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” heading_tag=” heading_class=” link=” linktarget=” linkelement=” id=” custom_class=” template_class=” av_uid=’av-15pfu60′ sc_version=’1.0′ admin_preview_bg=”]
An elliptical incisions is made around the scrotum and prepuce
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[av_image src=’http://focusandflourish.com/wp-content/uploads/2016/06/shih-tzu-puppy-300×227.jpg’ attachment=’182′ attachment_size=’medium’ copyright=” caption=” image_size=” styling=” box_shadow=’none’ box_shadow_width=’10’ box_shadow_color=” align=’center’ font_size=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’ animation_duration=” animation_custom_bg_color=” animation_z_index_curtain=’100′ parallax_parallax=” parallax_parallax_speed=” av-desktop-parallax_parallax=” av-desktop-parallax_parallax_speed=” av-medium-parallax_parallax=” av-medium-parallax_parallax_speed=” av-small-parallax_parallax=” av-small-parallax_parallax_speed=” av-mini-parallax_parallax=” av-mini-parallax_parallax_speed=” hover=” blur_image=” grayscale_image=” fade_image=” appearance=” css_position=” css_position_location=’,,,’ css_position_z_index=” av-desktop-css_position=” av-desktop-css_position_location=’,,,’ av-desktop-css_position_z_index=” av-medium-css_position=” av-medium-css_position_location=’,,,’ av-medium-css_position_z_index=” av-small-css_position=” av-small-css_position_location=’,,,’ av-small-css_position_z_index=” av-mini-css_position=” av-mini-css_position_location=’,,,’ av-mini-css_position_z_index=” transform_perspective=” transform_rotation=’,,,’ transform_scale=’,,’ transform_skew=’,’ transform_translate=’,,’ av-desktop-transform_perspective=” av-desktop-transform_rotation=’,,,’ av-desktop-transform_scale=’,,’ av-desktop-transform_skew=’,’ av-desktop-transform_translate=’,,’ av-medium-transform_perspective=” av-medium-transform_rotation=’,,,’ av-medium-transform_scale=’,,’ av-medium-transform_skew=’,’ av-medium-transform_translate=’,,’ av-small-transform_perspective=” av-small-transform_rotation=’,,,’ av-small-transform_scale=’,,’ av-small-transform_skew=’,’ av-small-transform_translate=’,,’ av-mini-transform_perspective=” av-mini-transform_rotation=’,,,’ av-mini-transform_scale=’,,’ av-mini-transform_skew=’,’ av-mini-transform_translate=’,,’ mask_overlay=” mask_overlay_shape=’blob’ mask_overlay_size=’contain’ mask_overlay_scale=’100%’ mask_overlay_position=’center center’ mask_overlay_repeat=’no-repeat’ mask_overlay_rotate=” mask_overlay_rad_shape=’circle’ mask_overlay_rad_position=’center center’ mask_overlay_opacity1=’0′ mask_overlay_opacity2=’1′ mask_overlay_opacity3=” link=” target=” title_attr=” alt_attr=” img_scrset=” lazy_loading=’disabled’ id=” custom_class=” template_class=” av_element_hidden_in_editor=’0′ av_uid=’av-131kmc8′ sc_version=’1.0′ admin_preview_bg=”][/av_image]

[av_icon_box icon=’ue885′ font=’entypo-fontello’ title=’Step 4′ position=’left’ icon_style=’av-icon-style-no-border’ boxed=” font_color=” custom_title=” custom_content=” color=” custom_bg=” custom_font=” custom_border=” custom_title_size=’14’ av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” custom_content_size=” av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” heading_tag=” heading_class=” link=” linktarget=” linkelement=” id=” custom_class=” template_class=” av_uid=’av-zbrg4o’ sc_version=’1.0′ admin_preview_bg=”]
An elliptical incisions is made around the scrotum and prepuce
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[av_image src=’http://focusandflourish.com/wp-content/uploads/2016/06/shih-tzu-puppy-300×227.jpg’ attachment=’182′ attachment_size=’medium’ copyright=” caption=” image_size=” styling=” box_shadow=’none’ box_shadow_width=’10’ box_shadow_color=” align=’center’ font_size=” overlay_opacity=’0.4′ overlay_color=’#000000′ overlay_text_color=’#ffffff’ animation=’no-animation’ animation_duration=” animation_custom_bg_color=” animation_z_index_curtain=’100′ parallax_parallax=” parallax_parallax_speed=” av-desktop-parallax_parallax=” av-desktop-parallax_parallax_speed=” av-medium-parallax_parallax=” av-medium-parallax_parallax_speed=” av-small-parallax_parallax=” av-small-parallax_parallax_speed=” av-mini-parallax_parallax=” av-mini-parallax_parallax_speed=” hover=” blur_image=” grayscale_image=” fade_image=” appearance=” css_position=” css_position_location=’,,,’ css_position_z_index=” av-desktop-css_position=” av-desktop-css_position_location=’,,,’ av-desktop-css_position_z_index=” av-medium-css_position=” av-medium-css_position_location=’,,,’ av-medium-css_position_z_index=” av-small-css_position=” av-small-css_position_location=’,,,’ av-small-css_position_z_index=” av-mini-css_position=” av-mini-css_position_location=’,,,’ av-mini-css_position_z_index=” transform_perspective=” transform_rotation=’,,,’ transform_scale=’,,’ transform_skew=’,’ transform_translate=’,,’ av-desktop-transform_perspective=” av-desktop-transform_rotation=’,,,’ av-desktop-transform_scale=’,,’ av-desktop-transform_skew=’,’ av-desktop-transform_translate=’,,’ av-medium-transform_perspective=” av-medium-transform_rotation=’,,,’ av-medium-transform_scale=’,,’ av-medium-transform_skew=’,’ av-medium-transform_translate=’,,’ av-small-transform_perspective=” av-small-transform_rotation=’,,,’ av-small-transform_scale=’,,’ av-small-transform_skew=’,’ av-small-transform_translate=’,,’ av-mini-transform_perspective=” av-mini-transform_rotation=’,,,’ av-mini-transform_scale=’,,’ av-mini-transform_skew=’,’ av-mini-transform_translate=’,,’ mask_overlay=” mask_overlay_shape=’blob’ mask_overlay_size=’contain’ mask_overlay_scale=’100%’ mask_overlay_position=’center center’ mask_overlay_repeat=’no-repeat’ mask_overlay_rotate=” mask_overlay_rad_shape=’circle’ mask_overlay_rad_position=’center center’ mask_overlay_opacity1=’0′ mask_overlay_opacity2=’1′ mask_overlay_opacity3=” link=” target=” title_attr=” alt_attr=” img_scrset=” lazy_loading=’disabled’ id=” custom_class=” template_class=” av_element_hidden_in_editor=’0′ av_uid=’av-wwqimw’ sc_version=’1.0′ admin_preview_bg=”][/av_image]

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An elliptical incisions is made around the scrotum and prepuce
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An elliptical incisions is made around the scrotum and prepuce
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Perineal Urethrostomy (PU) in Cats: Q&A
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How long do cats live after PU?

A PU cat can have a long life with a successful unblocking and surgery
Renal issues can be expected if they have had prolonged/multiple blockages
Cats presenting with severe azotemia are more prone to succumbing to renal failure if not managed quickly.

The cost of a PU surgery will vary greatly depending on:

Geographical location
Type of hospital (24 hour care hospital versus one that closes at night)
Condition of patient on presentation

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Preferred instrumentation for this surgery:

Post-operative Considerations

When is it time to perform a PU:

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How long do cats live after PU?

The cost of a PU surgery will vary greatly depending on:

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