Scrotal Urethrostomy in Alaskan Malamute at Animal Clinic Jakarta

Rahmat Ghulba Wicaksono

Program Studi Kedokteran Hewan, Fakultas Kedokteran Hewan, Universitas Brawijaya
rahmatghulba@gmail.com

ABSTRACT

Urinary obstruction in dogs is a case where the occurrence of a blockage in the

proximal urinary tract (renal pelvis and ureters) and the distal urinary tract (vesica urinaria
and urethra). One of the causes of lower urinary tract obstruction is urethral stricture. Urethral
stricture is scarring in or around the urethra that narrows or blocks the passageway through
which urine flows from the bladder. The treatment applied to urethral stricture cases is
uretrosthomy with scrotal ablation. The purpose of this final report is to know the ethiology,
clinical symptomps, diagnosis procedures and the therapy for lower urinary tract obstruction
in 2,5-years-old alaskan malamute. The supporting investigations that was done to determine
the diagnosis are complete blood count, blood chemistry, urinalysis, X-ray and USG.
Complete blood tests showed changes in some parameters like leukocytosis, monocytosis,
trombositopenia. For blood chemistry there was an elevated number of Ureum and Creatinin.
The therapy is uretrosthomy with scrotal ablation. Incision wound healing takes two weeks
without any postoperative complications, whereas total tissue healing generally takes up to
several weeks.
Keyword: urethrostomy, urethra, obstruction

A. Introduction
Urethral stricture is scarring in or asymptomatic, it is generally associated with
around the urethra that narrows or blocks the marked voiding symptoms, as scar
passageway through which urine flows from contraction continues to reduce the lumen
the bladder. Any process that injures the diameter.
urethral epithelium or the underlying corpus Urethrostomy is indicated for (1)
spongiosum to the extent that healing results recurrent obstructive calculi that cannot be
in a scar can cause a urethral stricture. managed medically; (2) calculi that cannot be
Urethral stricture generally refers to removed by retrohydropropulsion or
anterior urethral disease, or a scarring urethrotomy; (3) urethral stricture; (4)
process involving the spongy erectile tissue urethral or penile neoplasia or severe trauma;
of the corpus spongiosum (spongiofibrosis). and (5) preputial neoplasia requiring penile
The spongy erectile tissue of the corpus amputation.
spongiosum lies under the urethral This report will discuss about Scrotal
epithelium and the scarring process can Urethrostomy and Scrotal ablation in
extend through the tissues of the corpus Alaskan malamute . Based on the description 1
spongiosum into adjacent tissues, reducing above, this writing for the final assignment of
the urethral lumen. Although anterior Veterinary Professional Education (PPDH)
urethral stricture disease can initially be aims to find out more about etiology, clinical
symptoms, differential diagnose, and 2000). If the patient has been calm and
traement of Feline Infectious Peritonitis in anesthetized, an endotracheal tube (ETT) will
Animal Clinic Jakarta. be installed, isoflurane is administered 1.5 -
2.5% for maintenance of anesthesia by
B. Case Presentation
inhalation. Animals are placed on the
A 2,5 year old Male Alaskan malamute
operating table in a dorsal position, the head
dog was presented to Animal Clinic Jakarta
is given a rather high cushion, the ventral
with history of no appetite, weakness, and
portion of the mandible is cleaned using
inability to urinate. The dog had previously
soapy water and then shaved. After the hair
been operated several times to remove
has been shaved, 70% alcohol is given to the
calculi, cystotomy and a urethrotomy a
surgery site, then povidone iodine 3% is
month before presented on the clinic. This
applied. Then attach the sterile drape to the
dog also has a history of catheterization
surgery site.
procedures several times.
Ketamine as an Aaesthesia (10
So, cystocentesis was performed to
mg/BW) and Diazepam (0,5 mg/BW) was
alleviate bladder distention and discomfort.
injected intramuscularly. Endotracheal tube
A large amount of bloodtinged urine was
was placed for delivery of oxygen and
then retrieved. Haematologic investigations
Isoflurane to maintain anesthesia following
showed leukocytosis with a left shift and
induction. Antibiotic injections (Ampicillin
anaemia. Biochemical profile was consistent
10mg/kg BW) was administrated
with mild azotaemia. Urinalysis revealed a
intramucularly before the surgery.
specific gravity of 1.020, haematuria and
Analgesics (Meloxicam S. C dose 0.2 mL/ kg
proteinuria Hematology test showed
BB) were also given. The dog was restrained
leukocytosis, monocytosis, and
in dorsal recumbency position.
trombositopenia. And for the blood
Urethrostomy began with open
chemistry, there was an incresment level of
castration and scrotal ablation procedures.
BUN and Creatinin. Abdominal ultrasound
Elevate the Scrotum and testicles from body
examination had a hyperechoic picture of the
wall. Make an elliptical skin incision at the
bladder. The radioopaque density of the
base of the scrotum. Incise the vaginal tunics
bladder is seen on radiographic images.
and remove the testicles (open castration).
urethral rupture was confirmed with
Remove the scrotum after incising the
retrograde positivecontrast urethrography.
median septum. Place a sterile catheter into
The radiograph also shows a blockage in the
the urethra to the level of the ischial arch or
urethra which causes urination inability.
beyond. Make a midline incision over the
Scrotal Urethrostomy was decided as the
urethra through the subcutaneous tissue.
treatment for this case.
Identify the retractor penis muscle, mobilize
Operators and operator assistants must
it, and retract it laterally to expose the
be aseptic by washing hands with soap in
urethra. Using a No. 11 or 15 scalpel blade,
running water, wearing surgical gowns, caps,
make a 3- to 4-cm incision into the urethral
sterile latex gloves and masks. Aseptic
lumen over the catheter (Fig. 1). Suture the
conditions are very important in each 2
urethra, place simple interrupted absorbable
operation to minimize the contamination that
sutures from the urethral mucosa to the skin
occurs through operators and operator
(Fig. 2).
assistants who are not aseptic (Knecht et al.,
 than at other sites. Therefore postoperative
hemorrhage is often less than with other
techniques, and stricture is less likely.
Pre operation includes preparation of
tools, materials, surgery rooms and surgery
operators and assistants to minimize the
occurrence of contamination.
Patient were given sedation in the form
of ketamine and diazepam via intravenous
Fig.1 Incision into the urethral
(iv). Ketamine is an analgesic that inhibits
the work of the neurotransmitter glutamate
N-methil-Dasparate (NMDA) in the CNS
where NMDA is a pain reliever. The
combination of ketamine and diazepam can
reduce the effects of cardiovascular
stimulation and extend the action of ketamine
to 45 minutes. Inhalation sedation in the form
of 2% isoflurane is a halogen ethyl methyl
ether which will maintain anesthesia during
the operation (Ramsey, 2011).
Fig.2 Final simple interrupted sutures
The basic post-operative management
of urethrostomy is to prevent of any
C. Discussion complications include infection, reduce the
Diagnosis and general considerations in pain and to increase wound healing process.
various cases of urethral obstruction was The antibiotic that was used in this case was
made based on signalement, history and ceftriaxone and cefradoxil. Postoperative
clinical examination. A thorough physical therapy is administered cefradoxil (30 mg /
examination must be carried out. To be able kg BW) orally as an antibiotic, twice a day
to determine the diagnosis, several for seven days. Cefradoxil works to prevent
examinations is done, the first is a physical bacteria from forming cell walls that cause
examination. Therapy can be determined bacterial instability and death. Indications of
after passing the process. Therapy can be use of cephalexine are for prophylactic
surgical and non-surgical. As a requirement measures before surgery, effective for
for surgical therapy, a complete blood test septicemia, urogenital tract infections,
and blood chemistry must be performed to intraabdominal infections, and bone and joint
ensure that the animal is fit for surgery. infections (Plumb, 2008)
In the case of this dog, the cause of Patients in this case showed good
urethral stricture were prolonged postoperative development. There was no
catheterization procedures and previous complication reported after the surgery.
urethrotomy surgery.
D. Conclusion 3
Scrotal urethrostomy is preferred over
perineal or prepubic urethrostomy because Therapy and action in dogs with
the urethra is wider and more superficial and urethral stricture is scrotal urethrostomy.
is surrounded by less cavernous tissue here
Monitoring and evaluation of postoperative
success in this case was by monitoring the
general condition and pain reaction for pain
management after surgery with an evaluation
of the success of not appearing postoperative
complications.

E. Refference
Ettinger, Stephen J. 2017. TextBook of
Veterinary Internal Medicine :
Diseases of The Dog and Cat 8th
Edition. W.B. Saunders
Company. Philadelphia.
Fossum, T.W. 2002. Small Animal Surgery,
ed 2nd Mosby. St. Lois
London. Toronto. Philandelphia
Sydney.
Nelson, R.W. dan Couto, C.G., 2014. Small
Animal Internal Medicine 5th
Edition. Philadelphia : Mosby
Elsevier.
Plumb DC. 2008. Plumb’s Veterinar Drug
Handbook Sixth Edition. Iowa:
Blackwell Publishing Professional
Rowse, A.D., 2003. Urinary Tract
Obstruction. The Medicine
Publishing Company.
Shipov, A., Segev, G., 2013. Ureteral
Obstruction in Dogs and Cats.Israel J.
Vet Med 68: 71-76.
Tilley LP. dan Smith FWK. 1997. The 5
Minute Veterinary Consult : Canine
4
and Feline. Williams and Wilkins.
USA.