Figure 1
Place a large red rubber or stiffer PVC catheter up against the urolith. Occlude the penile orifice around the catheter
Managing Urethral Obstructions
What is a Urethral Obstruction?
Bladder stones becoming lodged in the urethra are the most common cause of obstruction. This occurs mostly in the male dog because they have a long urethra which narrows distally.
What is a Urethrotomy?
A urethrotomy is a surgical procedure that entails entering the urethra at the level of the obstruction to remove it. It is more difficult to remove stones through a urethrotomy than a cystotomy. The complication rate tends to also be higher with the urethrotomy. This is why it is better to retropulse the stones back into the bladder and remove them from there.
Situational Awareness
Retropulsing stones from the urethra is another LIFE SAVING procedure every veterinarian will need to perform someday.
If the obstruction is ACUTE, the dog will quickly become uncomfortable, anxious, and unable to pass urine despite frequent attempts. This is an emergency situation; the onset of azotemia is an indicator of severity. In acute cases retropulsion should be successful 100% of the time. Lack of success is usually due to inappropriate catheter selection and flushing technique. Follow the steps described here and ensure that your team (yes, you need a team for this) understands their role.
A CHRONIC obstruction usually results from a smaller stone being lodged in the urethra, typically at the level of or within the os penis. The stone is too large to be passed during micturition but is not so large that it fully obstructs the flow of urine. These patients present with a history of taking a long time to urinate, often with a very narrow stream. They may also display pollakiuria, dysuria and hematuria. These are by far the more difficult stones to dislodge and retropulse back into the bladder. Failure to successfully retropulse a stone from the urethra is more likely to occur with this patient.
Get ready to retropulse:
All the information you need.
Step by step explanations of the procedure.
This content is designed for veterinary professionals. If you are a pet owner, please consult your vet if you have any questions about a surgery.
Pre-procedural Considerations:
What the client needs to know:
Key points for a successful retropulsion (and watch the video!):
Place a large red rubber or stiffer PVC catheter up against the urolith. Occlude the penile orifice around the catheter
Quickly push a BOLUS of warm saline through the catheter. Often this is sufficient to dislodge the stones. If the stones have moved but have not completely cleared the urethra (as per radiographs), simply repeat these 2 steps. Check the size of the bladder frequently through out the procedure.
If steps 1&2 did not succeed in dislodging the stones then have an assistant occlude the pelvic urethra with a finger.
Then repeat steps 1&2; the bolus of warm saline against the occluded pelvic urethra will serve to expand the penile urethra.
As the warm saline is bolused into the urethra, the assistant will lift their finger off the floor of the pelvis, allowing the saline (and uroliths) to flow into the bladder. The occlusion/ unocclusion of the pelvic urethra is done intermittently while the saline is being bolused. Check the size of the bladder frequently through out the procedure.
Get ready to retropulse:
Instrumentation:
Post-obstruction actions:
What you get when you register:
Q & A
How long can dogs live with a urethral obstruction?
If the urethra is fully obstructed then 1-3 days at best, but what a horrible 1-3 days that will be for the dog!
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