Guess What I Saw?
by Travis Reed, DVM,
Chesapeake Veterinary Surgical Specialists
An 11 month old, castrated male,
domestic shorthaired cat was referred to a veterinary emergency
and referral clinic with a primary complaint of urinary
blockage. The referring veterinarian (rDVM) had diagnosed a
urethral obstruction earlier that afternoon, but could not pass
a urinary catheter. Serum biochemical analysis revealed a marked
azotemia with BUN > 130 mg/dL (reference range 16-36 mg/dL) and
creatinine 11.2 mg/dL (reference range 0.8-2.4 mg/dL);
hyperkalemia >10 mmol/L (reference range 3.5-5.8 mmol/L),
hyperphosphatemia 13.1 mg/dL (reference range 3.1-7.5 mg/dL);
and a mild anemia (Hct = 27.5% [reference range 30-45%]).
Urinary catheterization efforts by the emergency and surgery
services were unsuccessful. To empty the urinary bladder a
diversionary cystostomy tube was placed on an emergency basis
under a brief anesthesia.
The cat was maintained on crystalloid intravenous fluid therapy
(0.9% NaCl at 200ml/kg/d weaned down to 134ml/kg/d), a fentanyl
constant-rate infusion (CRI; 3mcg/kg/hr), and Timentin (50mg/kg
IV q8h) over the next 48 hours until the azotemia and
electrolyte abnormalities returned to the reference range.
A contrast cystourethrogram was performed by instilling
radiographic contrast material through the cystostomy tube
(Figure 1) since a retrograde urethrogram could not be performed
due to the inability to catheterize the urethra. The contrast
study demonstrated obstruction of the caudal pelvic urethra at
the level of the ischium. Definitive surgical correction of the
urethral obstruction would entail a urethrostomy. The location
of the obstruction was too far cranial for a perineal
urethrostomy, however; thus leaving the options of a transpelvic
(or transischial), transpubic, or prepubic urethrostomy. The cat
was taken to surgery for a transpelvic urethrostomy.
Postoperatively the cat was maintained on maintenance
crystalloid intravenous fluid therapy (Isolyte S, 100ml/kg/d
weaned down to 66ml/kg/d), a fentanyl CRI (3mcg/kg/hr weaned
down to 2mcg/kg/hr), and Timentin for the next 2 days. Urinary
diversion through the cystostomy tube was continued for an
additional 12 hours before the cystostomy tube was capped. The
cat began producing urine through the new urethral stoma with no
complications, and he was discharged 2 days postop. The owners
were instructed to monitor the cystostomy tube site for signs of
infection or damage to the tube, and were provided with a
plastic restraint collar for the cat. Discharge medications
included buprenorphine (0.01mg/kg PO q8-12h PRN) for analgesia
and Clavamox Drops (62.5mg PO q12h).
The cat returned 13 days after definitive surgery for
reevaluation, suture removal, and cystostomy tube removal. He
was reportedly urinating well at home, and the owners had no
concerns. A urine culture collected at surgery resulted in no
growth. The cat was reevaluated at 8 weeks post-operatively. He
was urinating well, and the owners had no concerns. The
urethrostomy stoma had healed well and was of adequate size.
This was a satisfactory recheck, and no further follow-ups were
needed. The owners were cautioned that the cat might be at risk
for urinary tract infections due to the shortened urethra.
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