RU2790961C1 - Method for conducting urethrostomy in cats - Google Patents

Abstract

FIELD: veterinary medicine; veterinary surgery.

SUBSTANCE: after longitudinal cutting of the urethra and formation of the penis stump, the scrotum skin is sutured to the mucous membrane of the urethra at a dorsal pole of the formed urethrostome. The mucous membrane of the urethra of the penis stump is sutured to the medial edge of the inner leaf of the prepuce. Scrotum and perineal area skin is sutured to the inner leaf of the prepuce, and a skin fold in the form of the vulva labia in females is formed.

EFFECT: method allows for prevention of damage and contamination of the urethrostome, which reduces a number of postoperative complications, including bacterial cystitis.

1 cl, 8 dwg

Description

The invention relates to methods for forming a urethrostomy during perineal urethrostomy in cats.

It is known that perineal urethrostomy is not a new method of surgical treatment of urethral obstruction (Fossum Т.W., 2013). Despite this, the study and comparison of its various techniques, as well as possible complications and long-term consequences, continues.

The following techniques for urethrostomy are known:

Classical technique (Fossum T. W., 2013) (Fig. 1):

A. an elliptical incision of the skin and subcutaneous tissues is made with the capture of the skin of the prepuce and the skin around the scrotum (Fig. 1, 1);

B. using a catheter or probe as a guide, a longitudinal incision is made in all layers of the ventral wall of the urethra (Fig. 1, 2);

C. The urethral mucosa is sutured to the skin with simple knotted sutures (Fig. 1, 3).

The disadvantage of this method is a large number of complications. The most common complications of perineal urethrostomy are hematomas, urine infiltration of subcutaneous fat in the area of urine leakage between the urethral mucosa and the skin, re-obstruction of the urethra by blood clots and / or due to swelling of the urethral mucosa and periurethral tissues, excoriation of the perineal skin and suture failure (Smeak D.D. , 2006). In the long term, complications of perineal urethrostomy may include chronic skinfold dermatitis, bladder hypotension, urinary incontinence, urethral strictures, repeated urethral obstructions, and chronic infections (Goh C.S.S., 2014). The frequency of complications of perineal urethrostomy is, according to the literature, 31.8-42.0% (Frem D.L., 2017; Sousa R.P., 2019). Urethral strictures and overgrowth of the urethrostomy, according to different authors, range from 12.0% (Tobias K.M., 2007) to 35.0% (Semenov B.S., 2018).

The disadvantage is that when performing a urethrostomy according to the classical method, the urethral mucosa left on the stump of the penis is gradually reduced and after two months at control examinations we observe a urethrostomy, the diameter of which is less than the diameter of the urethra during surgery. Over time, the urethrostomy still decreases, and within a year after the operation, we detect either a strong narrowing or even complete overgrowth of the urethrostomy, even with a technically correctly performed urethrostomy.

The technique using the inner leaf of the prepuce (lat. Lamina interna praeputii) differs from the classical technique in the following features (Fig. 2) (Nazarova A. V., 2021):

A. an elliptical skin incision is made around the scrotum, without capturing the foreskin (Fig. 2, A);

B. the inner leaf of the prepuce is cut along and dissected from the glans penis (Fig. 2, B);

C. after a longitudinal incision of the urethra and the formation of the stump of the penis, the mucous membrane of the urethra is sutured to the medial edge of Lamina interna praeputii (Fig. 2, C);

D. the skin around the urethrostomy is sutured to the lateral edge of the Lamina interna praeputii (Fig. 2, D).

Thus, a urethrostomy is formed, in which the urethral mucosa is connected to the Lamina interna praeputii, and the inner sheet of the prepuce, and not the urethra, is connected to the skin (Fig. 3, A and B). There, they prevent overgrowth of the urethrostomy and its stricture.

When performing a perineal urethrostomy using Lamina interna praeputii, the inner layer of the prepuce acts as a protective intermediate layer in the reconstruction of the urethra. And after the reduction of the mucous membrane of the urethra, a strip of Lamina interna praeputii remains around the urethrostomy, which protects the urethrostomy from narrowing.

However, it is known that a frequent (16.7% of cats) short-term complication is dysuria, and a frequent long-term complication (33.3% of cats) is recurrent urinary tract infection (Watson M.V., 2020). According to Sousa R.R. bacteriuria is present in 77.2% of cats with perineal urethrostomy (Sousa R.P., 2019). The presence of bacteriuria after urethral reconstructive surgery is part of the general problem of urinary tract infections, as they are one of the most frequent indications for the use of antimicrobials in veterinary medicine and contribute to the global problem of antimicrobial resistance (DorschR., 2016, 2019; Teichmann -Knorrn S., 2018). It should be taken into account that postoperative urinary tract infections can lead to repeated urethral obstructions (Nikousefat Z., 2018).

The disadvantage of the technique using the inner sheet of the prepuce is that the urethrostomy still remains open to possible damage and contamination.

Therefore, we have invented an operation technique using the inner leaf of the prepuce, which ensures the prevention of damage to the urethrostomy and bacterial cystitis.

The technical result of the invention consists in the formation of a skin fold around the urethrostomy, which makes it possible to prevent damage and contamination of the urethrostomy and the resulting bacterial cystitis.

The technical result is achieved due to the fact that a linear incision of the skin of the prepuce and scrotum is performed, then the skin is sutured to the urethral mucosa at the dorsal pole of the formed urethrostomy, then the skin is sutured to the inner leaf of the prepuce, a skin fold is formed in the form of the pubic lips of the vulva (Labium pudenda vulvae) in females.

The essence of the invention is illustrated by the following figures:

Fig. 1. Conducting urethrostomy according to the classical technique (Fossum T.W., 2013, p. 749)

Fig. 2. Technique for performing urethrostomy using the inner sheet of prepuce in a cat

Fig. 3. Formed urethrostomy in two cats

Fig. 4. The skin of the scrotum is sutured to the formed urethrostomy

Fig. 5. Condition of the skin fold and urethrostomy on the 4th day after the operation

Fig. 6. Condition of the skin fold on the 7th day after the operation

Fig. 7. 20th day after surgery

Fig. 8. Condition of the skin fold (A) and urethrostomy (B) 2 months after surgery

The method of urethrostomy with the formation of a skin fold around the urethrostomy in cats is as follows:

1. perform a linear incision of the skin of the prepuce and scrotum;

2. The inner sheet of the prepuce is cut lengthwise and dissected from the head of the penis;

3. after a longitudinal incision of the urethra and the formation of the stump of the penis, the skin of the scrotum is sutured to the mucous membrane of the urethra at the dorsal pole of the formed urethrostomy;

4. The mucous membrane of the urethra of the stump of the penis is sutured to the medial edge of Lamina interna praeputii;

5. The skin of the scrotum and perineal region is sutured to the inner sheet of the prepuce and a skin fold is formed in the form of the pubic lips of the vulva (Labium pudenda vulvae) in females (Fig. 4, Fig. 5, Fig. 6, Fig. 7, Fig. 8).

The formed skin fold protects the urethrostomy from contamination and damage (including by the animal itself), which reduces the number of postoperative complications, including bacterial cystitis.

Formed skin fold (castration was performed in the midline of the scrotum before urethrostomy, the skin of the scrotum was not removed) (Fig. 4).

Urination is free, the skin fold does not interfere with the discharge of urine.

T. o. filler granules that adhere to the skin but do not enter the urethrostomy and do not irritate it. Many cats, once used to a particular litter, may refuse to go to an empty litter box. Therefore, it is important that we can enable the cat to walk in his usual litter immediately after the operation.

On the 4th day after the operation, the edema subsided, the skin of the scrotum was reduced (Fig. 5). The mucous membrane of the urethra in the depth of the skin fold without signs of inflammation. There are no signs of urinary dermatitis.

On the 7th day after the operation, the urethrostomy and postoperative sutures were not damaged in another animal, despite the fact that the cat removed the postoperative collar and traces of licking were visible on the skin fold (Fig. 6).

At the control examination on the 20th day after the operation, there were no signs of skin fold dermatitis, urine leakage and dysuria (Fig. 7).

Two months after surgery, the cat shows no signs of urinary tract infection or narrowing of the urethrostomy (Fig. 8).

Thus, the skin fold formed during perineal urethrostomy using the inner sheet of the prepuce protects the urethrostomy from contamination and damage (including by the animal itself), which reduces the number of postoperative complications, including bacterial cystitis.

Literature

1. Nazarova, A.V. Perineal urethrostomy using the inner leaf of the prepuce in cats / A.V. Nazarova, B.S. Semenov, T.Sh. Kuznetsova // Collection of scientific papers of the Eleventh International Interuniversity Conference on Clinical Veterinary Medicine in the Purina Partners format. - 2021. - S.

2. Semenov, B.S. Perineal urethrostomy in cats: pros and cons / B.S. Semenov, A.V. Nazarova // International Veterinary Bulletin. - 2018. - No. 2. - P.130-135.

3. Dorsch, R. Urinary Tract Infection and Subclinical Bacteriuria in Cats a Clinical Update / R. Dorsch, S. Teichmann-Knorrn, H. S. Lund // Journal of Feline Medicine and Surgery. - 2019. - Vol. 21, # 11. - P. 1023-1038.

4. Dorsch, R. Urinary tract infections in cats. Prevalence of comorbidities and bacterial species, and determination of antimicrobial susceptibility to commonly used antimicrobial agents / R. Dorsch, P. von Vopelius-Feldt, G. Wolf, R. S. Mueller, R. K. Straubinger, K. Hartmann // Tieraerztliche Praxis Ausgabe Kleintiere Heimtiere. - 2016. - Vol. 44, # 4. - P. 227-236.

5. Fossum, TW Small Animal Surgery / Theresa W. Fossum, Curtis W. Dewey, Caroline V. Horn. - Elsevier, 2013. - ^4th Edition - 1775 p.

6. Frem, D.L. Use of poliglecaprone 25 for perineal urethrostomy in cats: 61 cases (2007-2013) / D. L. Frem, H. A. Hottinger, S. L. Hunter, N. J. Trout // Javma-Journal of the American Veterinary Medical Association. - 2017. - Vol.251, # 8. - P. 935-940.

7. Goh, Clara S.S. Feline Perineal Urethrostomy ventral approach / Clara S.S. Goh, Howard B. Seim // Today's Veterinary Practice. - 2014, July/August. - P. 43-49.

8. Nikousefat, Z. Obstructive bacterial cystitis following cystotomy in a Persian cat / Z. Nikousefat, M. Hashemnia, M. Javdani, A. Ghashghaii // Veterinary Research Forum. - 2018. - Vol. 9, #2. - P. 199-203.

9. Smeak, Daniel D. Avoiding and managing complications from perineal urethrostomies in cats / Daniel D. Smeak // Proceedings of the North American veterinary conference. - 2006. - P. 1452-1454.

10. Sousa, R. P. Clinical outcomes of 28 cats 12-24 months after urethrostomy / R. P. Sousa, D. C. S. Nunes-Pinheiro, K. O. Sampaio, E. C. B. da Silva, G. Cavalcanti, M. da Cunha // Journal of Feline Medicine and Surgery. - 2019. - P. 1-8.

11. Teichmann-Knorrn, S. Significant bacteriuria in cats: urinary tract infection and subclinical bacteriuria. A current review / S. Teichmann-Knorrn, R. Dorsch // Tieraerztliche Praxis Ausgabe Kleintiere Heimtiere. - 2018. - Vol. 46, #4. - P. 247-257.

12. Tobias, K. M. Perineal Urethrostomy in the Cat / Karen M. Tobias // NAVC clinician's brief. - 2007, march. - P. 19-22.

13. Tobias, Karen M. Perineal Urethrostomy in the Cat / Karen M. Tobias // NAVC clinician's brief. - 2007, march. - P. 19-22.

14 Watson, M.V. Evaluation of postoperative complication rates in cats undergoing perineal urethrostomy performed in dorsal recumbency / M.V. Watson, R.Y. Roca, A.H. Breiteneicher, R.H. Kalis // Journal of Feline Medicine and Surgery. - 2020. - Vol. 22, #4. - P. 399-403.

Claims (1)

A method for forming a urethrostomy in cats, including making a linear incision of the skin of the prepuce and scrotum, dissecting the inner sheet of the prepuce, characterized in that after a longitudinal incision of the urethra and formation of the stump of the penis, the skin of the scrotum is sutured to the urethral mucosa at the dorsal pole of the formed urethrostomy, the mucosa of the urethra of the stump the penis is sutured to the medial edge of the inner leaf of the prepuce, the skin of the scrotum and perineal region is sutured to the inner leaf of the prepuce and a skin fold is formed in the form of the pubic lips of the vulva in females.

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