Urethropexy

From Dog

Urethropexy is a surgical intervention for treatment of canine incontinence.

Urethropexy is an alternative to colposuspension that is aimed at restoring the bladder neck and proximal urethra to an intraabdominal position while simultaneously increasing resistance to urine flow by reducing the diameter of the urethral lumen[1]. As with other procedures intended to increase tension within the urethral wall, transient or persistent dysuria as a result of partial urethral obstruction and failure to improve continence were the most common complications noted in both studies.

Position the patient in dorsal recumbency and clip and aseptically prepare the ventral abdomen. Perform a caudal midline celiotomy from the umbilicus, extending over the cranial aspect of the pubis. Expose the bladder, urethra, and uterine body remnant and place a stay suture through the apex of the bladder for cranial traction. Using blunt dissection, clear the periurethral fat from the ventral aspect of the bladder neck and pelvic urethra. Pre-place six to 10 horizontal mattress sutures bilaterally using a 2-0 nonabsorbable monofilament suture material. The sutures should enter the abdominal cavity, passing full thickness through the ventral abdominal wall, including the rectus fascia. They should then pass through the seromuscular layer of the urethra in a horizontal mattress pattern at either the nine or three o'clock position in the transverse section without penetrating the urethral lumen. The sutures then exit from the abdominal cavity through the abdominal wall, including the rectus fascia, on the same side. The two most caudal sutures on either side of the urethra are engaged through the prepubic tendon as they enter and exit the abdomen. Tighten and tie the pre-placed sutures from caudal to cranial on each side of the urethra. Close the abdomen routinely.

Some degree of stranguria and dysuria will occur after surgery due to the increased outflow resistance created within the urethral lumen. Stranguria may persist for several weeks after surgery. The patient's voiding patterns should be observed daily for the first few days after surgery to be sure a small stream of urine is passed with each voiding effort. Complete urethral obstruction is uncommon. Attempts to pass a urethral catheter after surgery may be difficult and traumatic to the surgical site within the urethra and should be avoided if at all possible. Administration of an NSAID for 7 to 10 days after surgery is indicated to reduce discomfort and soft tissue swelling.

References

  1. Massat BJ, Gregory CR, Ling GV, et al (1993) Cystourethropexy to correct refractory urinary incontinence due to urethral sphincter mechanism incompetence preliminary results in ten bitches. Vet Surg 22(4):260-268