Management of traumatic urethral rupture in 11 cats using primary alignment with a urethral catheter

Summary

Objective: To assess the management of traumatic urethral ruptures using a systematic attempt at urethral catheterisation. Methods: Eleven cats that had been diagnosed with a traumatic urethral rupture over a five- year period were included in this study. Rupture was assessed by positive-contrast retrograde urethrography. An attempt was made to manage these ruptures by placing an indwelling urethral catheter. Results: The placement of an indwelling urethral catheter, could be performed in 10 out of 11 cats, which indicated a partial rupture. In one cat, catheterisation was not possible because of complete urethral rupture. A urethral catheter was placed into the urinary bladder via the urethra in five animals. In the other five animals, urethral catheterization required cystotomyusing a modified ‘inside to outside’ technique. Urethral catheter removal occurred between five and 14 days after placement. Urethral healing was accomplished in all cases of catheterisation with a good outcome in eight of the 10 cats. Two cats showed clinical signs related to stricture formation during the follow-up period (seven to 72 months). Retrograde urethrography provided a definitive diagnosis of partial rupture in only six of the 10 cases of partial rupture. Clinical significance: Results suggested that primary alignment with the placement of a urethral catheter should be attempted for the management of traumatic urethral ruptures in cats. Gentle urethral catheterisation seems to be an effective procedure for diagnosing and dealing with partial urethral rupture in cats. Clinical stricture formation can occur, but the risk does not seem to be high. Further studies are warranted in order to define the ideal duration for maintenance of an indwelling urethral catheter in cases of traumatic partial urethral rupture.

Keywords

Urethra - rupture - trauma - cats - catheterisation

• References

• 1 Selcer BA. Urinary tract trauma associated with pelvic trauma. JAmAnim Hosp Assoc 1982; 18: 785-793.
• 2 Kolata RJ, Johnston DE. Motor vehicle accidents in urban dogs: astudy of600 cases. JAmVetMed Assoc 1975; 167: 938-941.
• 3 Anderson RB, Aronson LR, Drobatz KJ. et al. Prognostic factors for successful outcome following urethral rupture in dogs and cats. J Am Anim Hosp Assoc 2006; 42: 136-146.
• 4 Boothe HW. Managing traumatic urethral injuries. Clin Tech Small Anim Pract 2000; 15: 35-39.
• 5 Aumann M, Worth LT, Drobatz KJ. Uroperitoneumincats: 26 cases (1986–1995). JAmAnim Hosp Assoc 1998; 34: 315-24.
• 6 Anson LW. Urethral trauma and principles of urethral surgery. Compend Contin Educ Pract Vet 1987; 9: 981-988.
• 7 Ticer JW, Spencer CP, Ackerman N. Positive contrast retrograde urethrography: a useful procedure for evaluating urethral disorders in the dog. VetRadiol 1980; 21: 2-11.
• 8 Holt PE. Hind limb skin loss associated with urethral rupture in two cats. J Small Anim Pract 1989; 30: 406-409.
• 9 Bjorling DE. The urethra. In: Textbook of Small Animal Surgery. Slatter D. (ed). Philadelphia: Elsevier Science; 2003: 1638-1651.
• 10 Fearnside SM, Eaton-Wells RD, Davey TN. Surgical management of urethral injury following pelvic trauma in three cats. Aust Vet Practit 2003; 33: 2-7.
• 11 Rawlings CA, Wingfield WE. Urethral reconstruction in dogs and cats. J Am Anim Hosp Assoc 1976; 12: 850-860.
• 12 Baines SJ, Rennie S, White RAS. Prepubic urethrostomy: a long term study in 16 cats. Vet Surg 2001; 30: 107-113.
• 13 Bass M, Howard J, Gerbert B. et al. Retrospective study of indications for and outcome of perineal urethrostomy in cats. J Small Anim Pract 2005; 46: 227-231.
• 14 Bernade A, Viguier E. Transpelvic urethrostomy in 11 cats using an ischial ostectomy. Vet Surg 2004; 33: 246-252.
• 15 Bellah JR. Problems of the urethra: surgical approaches. ProblVetMed 1989; 1: 17-35.
• 16 Bellah JR. Wound healing in the urinary tract. Semin Vet Med Surg (Small Anim) 1989; 4: 294-303.
• 17 Degner DA, Walshaw R. Healing responses of the lower unnary tract. Vet Clin North Am Small Anim Pract 1996; 26: 197-206.
• 18 Weaver RG, Schulte JW. Experimental and clinical studies of urethral regeneration. Surg Gynecol Obstet 1962; 115: 729-736.
• 19 Layton CE, Ferguson HR, Cook JE. et al. Intrapelvic urethral anastomosis: a comparison of three techniques. Vet Surg 1987; 16: 175-182.
• 20 Bonn TA, Van der Werken C. Urethral injuries revisted. Injury 1996; 27: 533-538.
• 21 Raney AM. Radiographic findings immediately after urethral rupture: an experimental study and case reports. JUrol 1976; 116: 581-582.
• 22 Bailly G, Kodoma R. Management of posterior urethral injuries after pelvic trauma. Curr Orthop 2003; 17: 245-253.
• 23 Cooley AJ, Waldron DR, Smith MM. et al. The effects of indwelling transurethral catheterization and tube cystotomy on urethral anastomoses in dogs. JAmAnimHosp Assoc 1999; 35: 341-347.
• 24 Bellah JR. Practical urine diversion and salvage procedures. Proceedings of the 8th Annual ACVS Veterinary Symposium 1998; pp 375-377.
• 25 Hay CW, Rosin E. Repair of an intrapelvic urethral tear in a bitch caused by iatrogenic trauma. Vet Rec 1997; 140: 48-49.
• 26 Yerasimides J, Roberts CS. Pelvic fractures and genitourinary injuries. Curr Orthop 2005; 19: 354-361.
• 27 Barsanti JA, Blue J, Edmunds J. Urinary tract infection due to indwelling bladder catheters in dogs and cats. J Am Vet Med Assoc 1985; 187: 384-388.
• 28 Lees GE. Use and misuse of indwelling urethral catheters. Vet Clin North Am Small Anim Pract 1996; 26: 499-505.
• 29 Lees GE, Osborne CA, Stevens JB. et al. Adverse effects of open indwelling urethral catheterization in clinically normal male cats. Am J Vet Res 1981; 42: 825-833.
• 30 Barsanti JA, Shotts EB, Crowell WA. et al. Effect of therapy on susceptibility to urinary tract infection in male cats with indwelling urethral catheters. J Vet Intern Med 1992; 6: 64-70.
• 31 Michielsen DP, Wyndaele JJ. Management of false passages in patients practising clean intermittent self catheterisation. Spinal Cord 1999; 37: 201-203.
• 32 Upadhyaya M. Freeman NV Management of traumatic urethral disruption in children: Oman experience, 1988-2000. J Pediatr Surg 2002; 37: 1451-1455.
• 33 Brandes S. Initial management of anterior and posterior urethral injuries. Urol Clin North Am 2006; 33: 87-95.
• 34 Moudouni SM, Patard JJ, Manunta A. et al. Early endoscopic realignment of post-traumatic posterior urethral disruption. Urology 2001; 57: 628-632.
• 35 Beaghler MDM, Grasso MDM, Loisides MDP. Inability to pass a urethral catheter: the bedside role of the flexible cystoscope. Urology 1994; 44: 268-270.
• 36 Kielb SJ, Voeltz ZL, Wolf Jr. JS. Evaluation and management of traumatic posterior urethral disruption with flexible cystourethroscopy. J Trauma 2001; 50: 36-40.
• 37 Chapple CR. Urethral injury. BJU Int 2000; 86: 318-326.