To relieve the obstruction, conceretions lodged in the distal penis are first milked out by gently

rolling the penis between the thumb and forefinger. Additionally, massaging the urethra through the
animals rectum may help to dislodge abdominal or pelvic urethral concretions. Voiding is then
induced by gentle urinary bladder palpation. If urethral massage and bladder expression fail to
dislodge the obstruction, retrograde urethral flushing is attempted to dislodge the concretion into
the bladder by hydropropulsion.

The penis is exposed, washed, and a 3.5-French open-ended tomcat catheter, lubricated with a
sterile gel, is placed into the distal urethra. Once the catheter has been placed, the prepuce is
grasped digitally and is retracted caudodorsally, so the urethra is parallel to the vertebral column. A
12 ml syringe containing sterile saline or lactated ringers solution is then connceted to the catheter
by an assistant. Subsequently, fluid is forced through the catheter while the catheter is gently
advanced : the catheter should remain parallel to the spine during this maneuver. This technique
should force the concretion into the bladder. The catether is then advanced into the bladder, which
is then repeatedly flushed and emptied to remove as much debris as possible. This catheter is then
removed and is replaced with a 5-french catheter cut to a lenght of 6 cm. This catheter is possitioned
so the tip just is just past the root of the penis. This reduces the possibility of ascending cystitis. The
catheter is sutured in place and is removed in 5 day. If urethral patencycannot be restored by this
method, one should suspect a mural or periurethral lesion with or without an associated urethral
plug.

Antibiotics are given for 30 days. Three different drugs are used for 10 days each. The cats diet is
changed to prescription diet feline multicare. This diet is low in magnesium and tends to acidify the
urine, thus decreasing crystal formation. The food should be salted to increase fluid intake and to
promote diuresis, to flush out urinary bacteria and precipitates. Instead of salting the food, the
owner may administer a 1 g salt tablet orally once a day. If obstruction recurs, perineal
uresthrostomy is indicated.

Figure 31.9 after the perineal area is draped and a urinary catheter is placed, an elliptic incision is
made around the scrotum and prepuce

Preoperative considerations

Cats who have had urinary travt obstruction are poor anesthetic risks. Diuresis after unblocking is
indicated. Induction of anesthesia with an ultrashort acting anesthetic agent followed by
maintenance with a gas anesthetic is recommended

Surgical technique

The animal is prepared for aseptic surgery. The hair is clipped from the entire perineal area including
the base of the tail. A puesestring suture is placed in the anus and a 3.5 french open ended tomcat
catheter is placed. The animal is positioned on the surgery table in ventral recumbency with the hind
legs draped over the end of a titled table. The tail is taped over the dorsal midline of the back and
the genital area is draped.

An elliptic incision starting halfway between the anus and scrotum is made around the scrotum and
prepuce (31.9) if the animal is sexually intact, castration is performed. After the penis with
accompanying prepuce and remaining scrotum are retracted dorsally, ventral dissection is begun
with Matzenbaum scissors at their urethral attachments (31.11) . this technique frees the penis and
allows the visualization of a ventral peline fibrous band from the pelvic diaphragm located on the
midline between the penis and the ischial arch. This structure is then cut, further freeing the penis.

Figure 31.10 the penis and prepuce are retracted dorsally and ventral dissection is begun

At this point, dorsal dissection is begun. All dorsal dissection is accomplished close to the urethra.
Metzenbaum scissors are used to cut and bluntly dissect the attachments circumferentially, further
freeing the urethra and allowing it to be retracted caudaly. The dorsal white V shaped uterus
musculinus is now visible and is cut close to the urethra (31.12). Care must be exercised during the
entire dissection not to damage the rectum (dorsally) and the nerves that innervate the rectum and
bladder neck. Such damage is avoided by keeping all dissection close to the urethra.

31.11 the ischiocavernosus muscle is identified and is cut with scissors close to the penile
attachment

31.12 urethral dissection is completed by transecting the V-shaped uterus masculinus close to the
urethra

31.13 the urethra is incised into the lumen with a no 10 scalpel

The dissected penis is grasped in the surgeons left hand, with the index finger under the penile crus.
A no 10 scalpel is used to incise over the catheter on the dorsal midline of the urethra (31.13). The
incision is extended 1 cm cranial and 2 sm caudal to the crus of the penis. Extention of the pelvic
uretharl incision more than 1 cm cranial to the crus leads to severe incisional invagination when the
incision is sutured. A 1 cm incision in the pelvic urethra is adequate to provide the enlarged opening
needed. The catheter is removed, and forceps are inserted into the pelvic urethra (31.14). the
incision is now ready for suturing.

We recommend using 4-0 polydioxanone or polypropylene with a swaged on taper cut needle for
urethral suturing. The first suture is placed to approximate the most dorsal skin edges. The next
suture, which begins the urethral suturing, picks up one skin edge and then passes through the
dorsal roof tho the urethra just cranial to the most cranial incision edge and then through the other
skin edge (31.15) when this suture is tied, the roof of the urethra is pulled up to the skin edge, thus
lifting the urethra to the surface. Suturing is continued down the skin incision on each side, including
the cut edge of the urethral mucosa in each stich (31.15B). it is important also to include the edge of
the corpus spongiosum (coepus cavernosum urethra) within these urethral edge stiches to help
control hemorrhage from the cut edge of the corpus spongiosum. After both sides of the skin
incision have been sutured, the penis is cut off with scissors (31.16A) at the level of the caudal
urethral incision. The cut end (31.16B) is sutured as shown in (31.17). this helps to seal the cut end
of the corpus cavernosum penis and eliminates much of the excessive postoperative hemorrhage
often encountered with this surgical procedure. The final sutures are placed approximating the
caudal skin edges (31.18). The wide end of the tomcat catheter is cut (approximately 2,5) inserted
into the new urethral opening and sutured to the skin on each side (31.18)

31.14 after the incision is completed, the catheter is removed and forceps are inserted into the
pelvic urethra
31.15A the firs suture approximates the dorsal skin edges, then the first urethral suture is placed
engaging both skin edges and the pelvic urethral roof. B . urethral suturing continues down the skin
incision on each side.