Prepubic urethrostomy with removal of the urethra into the preputial sac in a dog. Prostatitis, prostate abscess

Urethrostomy in dogs– surgical intervention aimed at forming a new functional opening in the urethra. Blockage urethra– the disease, although rare in male dogs, still “has a place to be”, the specialists of the DobroVet veterinary center more than once had to save pets from urolithiasis.

Features of postoperative care

The owner of a male dog should remember that urethrostomy in dogs only helps to prevent blockage of the urethra; the reasons that contributed to the occurrence of this disease require treatment and regular visits veterinary center for periodic inspection. After surgery, there is a risk of drift and development infectious agents in the bladder, which is directly related to the presence of sand and stones in it. After urethrostomy, it is important for a male dog to remain in the hospital for several days in order to monitor the outflow of urine and promptly prevent possible complications. If everything is fine with the pet, he is discharged home, but the owner must follow all the recommendations of the attending physician, treat the sutures, and prevent them from licking (the dog must be wearing a protective collar).

Within 10-14 days, the dog may have involuntary urination; the owner must be prepared for this and in no case scold the pet. It is possible to use a special diaper for dogs. The course of rehabilitation therapy necessarily includes antibiotic therapy and monitoring of drug intake with a general clinical urine test.

A rare complication after surgery is cicatricial narrowing of the urethra (postoperative stricture). The pathology requires a repeat operation.

Preventive actions

It is important for the owner of a male dog to remember that urethrostomy in dogs can only be avoided if the pet is properly maintained and fed and has regular examinations of the genitourinary system. The absence of obvious symptoms does not mean that the dog is fine; a long latent course of the disease is possible. VC DobroVet specialists remind you that a problem noticed in time in genitourinary system the pet has the opportunity to avoid surgery. It is important to carry out an OCA of urine every 4-6 months (at 1-3 months) and, depending on the results, urine pH and the presence (absence) of sand and stones are prescribed special diet to prevent the formation of new microliths.

Veterinary center "DobroVet"

Urethrostomy in dogs is a type of surgical intervention performed for blockage of the urethra in male dogs. As a result of the operation, an artificial external opening is formed for urine to exit the body. WITH Greek language The name of the operation is translated as “urethra” - urethra and “stoma” - opening, that is, a new opening of the urethra is formed. It is called a urethral opening, urethrostomy, fistula or fistula.

The formation of urine by the kidneys is a constant, continuous process, and its excretion is controlled by the animal depending on the degree of filling Bladder.

Causes of urethral blockage in male dogs

The patency of the urethra may be completely or partially impaired. Predisposing factors for blockage are the narrowness of the lumen of the urethra with a sufficiently large length. The passage of urine from the bladder through the urethra can be prevented by:

Stones or a “plug” of sand in the urethra.
If there is a metabolic disorder, products of altered metabolism may be deposited in the kidneys, ureters and bladder. Their basis is salt crystals uric acids, held together by proteins. In the urinary system you can find single or multiple stones, the sizes of which vary from a few millimeters to 1.0-1.5 or more centimeters. Much smaller crystals are called sand. In practice, you can find either stones, or only sand, or a combination of both. Stricture of the urethra, that is, its compression, narrowing. It can be congenital or acquired during life. The cause may be inflammation, tumors, scars, injuries to the canal and nearby anatomical structures, congenital anomaly development of the urethra.
Tumors.
Injuries.
Other reasons.

Indications for urethrostomy in dogs

1) Painful urge to urination or strangury. In some cases painful urination may be accompanied by the release of only drops of urine.

Pain occurs in the bladder and/or urethra, as their walls are constantly irritated by stones and sand. In some cases, painful urination may be accompanied by the release of only drops of urine. In this case, the animal may whine, howl and make other sounds in pain. It is important to note here that pain during urination may have a different nature, for example, with bladder cancer, severe inflammation of the bladder wall or cystitis in dogs, inflammation of the prostate gland or prostatitis.

2) The absence of urination with a strong urge indicates a complete blockage of the urethra. If urine is not excreted from the body for a day or more, kidney failure develops with severe intoxication and death.

3) Bladder overflow.

4) Hematuria or blood in the urine, as an indicator of trauma to the mucous membrane. But red urine can be a symptom of other diseases.

Operation technique

Depending on the cause and location of the blockage, there are several types of urethrostomy.

1. Distal urethrostomy. It is performed if the stone is in the urethra and rests on the bone of the penis.

The operation consists of several stages. The first is urethrotomy, that is, dissection of the genitourinary canal. The second is urethrostomy, that is, the formation of an external opening. An incision is made above the blockage down to the urethral mucosa. The stone is removed. Next enter urethral catheter, through which the urethra is washed all the way to the bladder, thus checking its patency.

2. Perineal urethrostomy used in case of stones in the urethra in the perineal area, where the intervention is performed.

3. Scrotal urethrostomy carried out in case of stricture, as well as the presence of stones in the urethra. Surgery It begins by removing the testes and making an incision in the skin of the scrotum.

Postoperative care

A collar is needed that will protect the wounds and the urethral catheter from being licked.

The surgical wound must be treated and general recommendations must be followed.

If an animal has a catheter inserted into the urethra, then depending on the general condition, it is removed after about three to four days.

The threads after urethrostomy are removed after about 2-3 weeks.

It is worth understanding that after this operation, urination in the animal becomes involuntary. This occurs due to the fact that urine constantly leaks through the urethrostomy.

Remember that urethrostomy in case of impossibility of passing urine through the urethra is the only way save your dog's life. Delay in this situation may lead to serious consequences and complications.

– veterinarian therapeutic department ITC MBA

Anatomy of the prostate gland

Prostate(prostate) is an accessory gonad in males, performing secretory function, is the only accessory sex gland in males.

The prostate surrounds the proximal urethra at the bladder neck, and its ducts flow into the urethra in a circumferential manner. On the dorsal surface it is divided into two lobes with a septum in the middle. The prostate gland does not contain microorganisms. The function of the prostate gland is to produce secretion, which is a supporting and transporting medium for sperm during ejaculation.

Also, seminal fluid mechanically dilutes the sperm produced by the testes, increases the volume of ejaculate, and promotes the movement of viable sperm outside the male body. Basal secretion of small amounts of secretion leads to its constant entry into excretory ducts and the prostatic urethra.

The hormone testosterone is required to maintain the size and growth of the prostate gland. When castrating a male dog before puberty, normal height the prostate is suppressed. When a male dog is castrated as an adult, the gland involutes up to 20% of its normal size in an adult animal.

Diagnosis of prostate diseases

Anamnesis collection.
Examination with rectal palpation.
Cytological examination of any discharge from the urethra.
Analysis of urine.
Biochemical and clinical blood test.
X-ray examination.
Cytoloic and microbiological examination prostate secretion.
Ultrasonography.
Aspiration or percutaneous biopsy.

History taking

It is necessary to take a complete history, consider the main complaint and general state patient. Pay attention to the state of urination and defecation.

Physical examination (prostate palpation)

It is advisable to use the two-handed method. The prostate gland is palpated with a finger through the rectum in the ventral part of the pelvic canal. During palpation, it is necessary to evaluate the size, consistency, symmetry, contours, whether it is fixed or removable. Physical examination of the prostate through the rectum can be facilitated by simultaneous palpation of the caudal part abdominal cavity, by pressing on which you can move the gland more caudally along the pelvic canal. Normally, a healthy gland is smooth, symmetrical, and painless.

Urinalysis and bacteriological culture

Detection of hematuria, bacteriuria/pyuria in the urine analysis of an uncastrated male dog can always indicate the possibility of prostate diseases.

If you suspect an infectious process in the prostate, it is recommended to take bacteriological research sperm or urine. In this case, urine can be taken for bacteriological culture in several ways:

1) By cystocentesis (the gold standard for culture testing for urinary tract infections), but it should be taken into account that urine culture may be falsely negative if the prostatic secretion has not contaminated the contents of the bladder.

2) By taking a mid-portion of urine (in this case, possible contamination of pathogenic microflora from the distal part of the urethra should be taken into account).

Blood tests

Blood tests are necessary to exclude systemic diseases, screening hidden diseases in aging animals.

Serological tests designed specifically for the diagnosis of prostate diseases are currently not available.

Cytological examination of any urethral discharge

Discharge from the urethra

If prostate disease is suspected, it is necessary to examine the secretion of the gland in a male dog in order to determine the cause of the pathological process.

Any discharge from the urethra should be examined microscopically.

Bacteriological culture of the urethra should not be performed due to the presence of bacterial flora in the distal part of the urethra.

Sperogram

In males, sperm consists of 3 fractions

Urethral
Spermatic
Prostatic.

For diagnostic purposes, 2-3 ml of the third fraction is collected. For the accuracy of the result, cytological and cultural examination is required, since bacterial flora is normally present in the distal part of the urethra.

With diseases of the testes and appendages, the appearance and color of the ejaculate may change.

Prostatic secretion healthy dog contains a small number of leukocytes, epithelial cells, bacteria. Sperm pH 6.0-6.7.

Deviations during the study:

A large number of leukocytes.

A large number of red blood cells

Bacteria in large quantities located inside leukocytes and macrophages.

Macrophages containing hemosiderin.

When inoculating the ejaculate, a large number of gram-negative microorganisms in combination with big amount leukocytes indicates an infectious process, unless the sample was contaminated with preputial contents during collection.

In cases of suspected prostate neoplasm involving the prostatic urethra, the likelihood of the presence of atypical cells in samples obtained from prostate massage is greater compared with the likelihood of their presence in the ejaculate.

Radiography

X-rays provide information about the size and location of the prostate gland. The photographs can reveal its increase. However, radiography is of limited benefit. In many cases, palpation of the prostate can provide more accurate results.

For dysuria in dogs, the test of choice for prostate disease is remote retrograde urethrocystography.

With asymmetry of the prostate in relation to the urethra, narrowing of the prostatic part of the urethra, the following are most likely: abscess formation, parenchymal cysts, neoplasms, hyperplasia. If on x-ray there is a pronounced enlargement of the prostate, presumably associated with a neoplasm, radiographs of the organs should be studied chest and abdominal cavity, looking for signs of metastasis.

Ultrasonography

Ultrasound diagnostics is the best method for assessing the prostate gland. In this case, it is possible to determine the size and homogeneity of the prostate tissue.

The prostate parenchyma is homogeneous, of medium echogenicity with fine or medium granularity and smooth edges. In the sagittal projection, the shape of the organ is round or oval; in the transverse projection, it is estimated that both lobes are symmetrical.

The prostatic part of the urethra with its surrounding muscles and vertical suture is visualized as a hypoechoic structure located between the two lobes. Ultrasound diagnostics can determine the presence of inflammation of the prostate, abscess, prostate cysts, and prostate tumors.

It is necessary to examine the sublumbar The lymph nodes. During infectious processes or neoplasms, their increase or change in echogenicity may be observed.

Prostate biopsy

Under ultrasound control, a needle aspiration biopsy (14-18 G biopsy needles) is performed from intraprostatic cavity lesions to collect cellular material for cytological examination. When receiving an aspiration biopsy, the prostatic fluid should be examined microscopically, as well as bacteriological culture to detect pathogenic microflora.

Most a common complication Prostate biopsy reveals mild hematuria, but significant bleeding is also possible.
To avoid complications, before performing a biopsy, it is recommended to take a test to study the patient’s blood clotting - a coagulogram.

1. Percutaneous biopsy. Conducted via transabdominal access under ultrasound guidance, the animal is under sedation.

2. Surgical biopsy. X Surgical biopsy is performed using a biopsy needle by wedge-shaped resection of the parenchyma. Before performing a biopsy, cysts or areas of potential abscess should be aspirated. A sample of sublumbar lymph nodes should also be taken.

Urethroscopy

The prostatic urethra can be visualized using urethroscopy. In this case, it is possible to visualize the flow of exudate or bleeding into the prostatic part of the urethra and exclude non-prostate urethral lesions as the cause of urethral discharge.

Diseases of the prostate gland in males

Prostatitis, prostate abscess

Prostatitis is a nonspecific inflammation of the prostate gland. There are acute and chronic prostatitis. The most common infectious agent is coli, staphylococci, streptococci. The development of a chronic process is facilitated by the accumulation and stagnation of prostate secretions. Pathogenic microflora enters the prostate tissue ascendingly from the urethra. Most often, a prostate abscess occurs after incomplete cure of acute prostatitis.

Abscesses develop when severe course infection and encapsulation of pus.

Abscess formation is the result of chronic infection.

The source of infection of the prostate gland is usually the urethra.
Inflammatory process may spread to overlying areas urinary tract, which causes damage to the bladder, ureters and kidneys.

Symptoms:
Difficulty urinating (strangury), bloody or purulent discharge from the urethra, tenesmus, fever, anorexia, difficulty with bowel movements.

Diagnosis:
To make a diagnosis, an animal's medical history, a general clinical blood test, a biochemical blood test, a urinalysis and urine culture results, and an assessment of prostate secretions are collected.

Treatment:
The antibiotic selected based on culture results should be used for at least 28 days.

Castration is beneficial and can be a necessary condition resolution of chronic infectious process in the prostate gland.

Prostate abscesses require surgical drainage. Drainage is carried out under an ultrasonic king.

Benign hyperplasia, cystic hyperplasia

Benign prostatic hyperplasia is an increase in the number and size of epithelial cells. Prostatic hyperplasia is the most common pathology of the prostate gland. Almost 100% of uncastrated males, starting from 2.5 years of age, develop signs of prostatic hyperplasia as they age. This is a hormone-dependent process associated with a violation of the ratio of androgens and estrogens, and occurs exclusively in the presence of testes. Due to hyperplasia, intraparenchymal fluid cysts may develop. Most often, this pathology manifests itself over the age of 4 years.

Symptoms:
In most male dogs, the lesion may be asymptomatic. Sometimes there may be bloody issues from the urethra, hematuria, hematospermia.

Diagnosis:
Ultrasound diagnostics, prostate biopsy. The diagnosis is confirmed by a positive response to castration.

Treatment:
There are several treatments for prostatic hyperplasia.

Surgical castration results in a 75% reduction in prostate size within 8-10 weeks.
Chemical castration involves the use of estrogens or antiandrogens.

Hormone therapy in the form of estrogen is rarely used due to a number of side effects, toxic effect on the body, oppression bone marrow, development of diabetes mellitus.

Antiandrogens do not cause a number of side effects, unlike estrogens. There are drugs licensed for veterinary use.

On this moment Antiandrogens are the therapeutic choice of the veterinarian.

Prostate neoplasms

In older animals, the prostate gland is susceptible to neoplastic transformation.

Most often this malignant neoplasms. The prostate can be the site of metastasis or the site of primary formation. There are such neoplasms as: carcinoma, transitional cell carcinoma, adenocacyoma, lymphosarcoma, squamous cell carcinoma and hemangiosarcoma. Benign neoplasms prostate cancers such as leiomyoma are rare.

Symptoms:
Enlarged prostate with rectal examination, asymmetrical prostate gland. Difficulty urinating and defecating, urethral obstruction.

The tumor can grow into the bladder neck and can cause ureteral obstruction.

Prevails pathological changes urine, hematuria.

Diagnosis:
If the male dog has been neutered at a young age and he has a clear enlargement of the prostate gland, most likely the result of the enlargement may be a neoplasm.

To check for the presence of metastases in the lungs, it is necessary to conduct an x-ray of the organs of the ore cavity.

The bodies of the lumbar vertebrae and pelvic bones should be examined to identify foci of proliferative changes that suggest the presence of metastases.

It is necessary to conduct ultrasound diagnostics. In non-castrated males with a noticeable enlargement of the prostate gland, the neoplasm should be differentiated from prostate abscesses and paraprostatic cysts.
To establish a diagnosis, a prostate biopsy is necessary. The final diagnosis is made based on cytological or histopathological examination of prostate tissue samples.

Treatment:
Effective treatment at malignant formations the prostate gland does not exist. Sometimes, in the absence of metastases, it is possible to surgical intervention With complete removal prostate. But owners should be warned about probable development urinary incontinence after surgery. The goal is usually temporary tumor control and relief of clinical signs. Castration leads to a slight positive effect.

Squamous metaplasia of the prostate

With this pathology of the prostate gland, the appearance of the epithelium of the gland itself changes, and the level of estrogen increases. Basic endogenous cause is a functionally active Sertoli cell tumor. Estrogens can cause stagnation of secretions. This may predispose to the development of cysts, infection and abscess formation.

Symptoms:
The appearance of the testes may change, enlargement of one and atrophy of the other, as well as atrophy of both testes.
When estrogen levels increase, alopecia, hyperpigmentation, and gynecomastia may appear. The degree of enlargement of the prostate gland can vary.

Flat epithelium appears in large quantities in the ejaculate.

Diagnosis:
Presumptive diagnosis is based on a history of estrogen treatment. The final diagnosis is made by prostate biopsy.

Treatment:
If there is an exogenous increase in estrogen levels, estrogen therapy is stopped. If there is an endogenous increase, castration is necessary.

Paraprostatic cysts

Paraprostatic cysts are one or more fluid-filled sacs adjacent to the prostate gland and connected to it by a pedicle or adhesions.

Cysts may be different sizes. Large cysts can originate from the prostate or are remnants of the prostatic uterus. The etiology is not fully understood. These cysts can form from the capsule of the prostate gland or the walls of the bladder. At the same time, they often reach enormous sizes and move into the abdominal cavity or into the pelvic cavity.

Symptoms:
For cysts big size the urethra may be compressed and colon. Dysuria, tenesmus, urinary incontinence, urethral obstruction, and abdominal enlargement may occur. Sometimes present infectious lesion urinary tract with an infected cyst.

Diagnosis:
To make a diagnosis, it is necessary to collect anamnesis, conduct ultrasound diagnostics, and exclude ascites and abdominal tumors. Aspiration of fluid under ultrasound guidance is possible. The color of the fluid from the cyst is usually yellow,
serous-bloody, brown.

Treatment
Treatment is surgical. Castration is recommended. If infection is present, treat with antibiotics.

Bibliography

Sophia A.Yin the small animal veterinary nerbook - Complete guide By veterinary medicine small pets
Jonathan Elliott, Gregory F. Graer - Nephrology and urology of dogs and cats
Small Animal practice 4th edn/ed R Morgan,RBright
Atlas of Small Animal Anatomy, Thomas O. McCracken, Robert A. Kiner.
Blackwell’s five-minute veterinary consult canine and feline
Larry Patrick Tilley,DVM
Francis W.K.Smith, Jr., DVM – Diseases of cats and dogs
Pennick, D'Anjou: Atlas of ultrasound diagnostics. >Studies in dogs and cats

The anatomical features of the structure of the urinary tract in males of various animals (dogs, cats, etc.) are one of the main causes of obstruction (obstruction) of the urethra. Perineal urethrostomy - surgical method clearing blockages in the lower urinary tract. The operation does not affect the causes of the disease. It is a one-time radical solution to alleviate the patient's condition.

Indications for perineal urethrostomy

Most often, surgical intervention is performed in the case of strictures (pathological narrowings of the internal lumen) of the urethra, caused by prolonged urethritis of various natures. Also, the cause may be obstruction of the urethra of the penile part of the urethra, which cannot be eliminated by conservative (inoperable) methods. Other indications:

occlusion (closure) of the urethra by neoplasms or stones (stones, sand);
perforation (through breach of the wall) of the canal due to unsuccessful catheterization;
atony (relaxation) of the bladder;
recurrent obstruction;
fusion of the stoma (opening) as a result of a previously performed urethrostomy.

Preparation and performance of the operation

Important preparatory stage Before performing perineal urethrostomy, the location of the blockage is determined. Clinical (general) and biochemical tests urine and blood. Contraindications to urgent (urgent) perineal urethrostomy are collapse, shock and other critical conditions.

Along with general anesthesia They also perform epidural and regional. The use of the latter allows you to operate on animals with:

uremic syndrome;
acute renal failure;
other similar complications that arise due to prolonged dysuria (impaired urination).

During the operation, a long narrow section of the urethra is removed, the animal is castrated at the same time, and a new urethral opening (stoma) is created. In order for the swelling to subside and the stoma to remain wide for several days, a catheter or thick probe is installed. The stitches are removed after 10-14 days after complete healing.

Depending on the condition of the animal, it is left in the hospital for several days. IN postoperative period an infusion (administration through a dropper) of electrolyte solutions, pain relief and symptomatic therapy, a course of antibiotics is prescribed wide range. To prevent licking of wounds, the animal is wearing protective collar. It is also important to wear a disposable diaper with special slots for the tail.

Best veterinary clinic specialists provide professional assistance in eliminating urethral obstruction for small and large animals in Novosibirsk and the region. Regular inspections are also carried out every six months and clinical researches patient for possible relapse.

Prices, rub.

The price does not include consumables and additional work

Question answer

Good day. In your clinic, a dog (Labrador) underwent ACL surgery using the TPLO method. 04/16/2019 will be a month. There will be a similar one on the second paw. But there is a desire to sterilize the dog using the endoscopic method as soon as possible. We need to come to you on May 16, 2019 for a follow-up appointment and x-ray. Is it possible to have a dog sterilized on the same day? Or is it early? And all these manipulations can harm speedy recovery dogs (taking into account the fact of the frequency of use of anesthesia and other medications), as well as the recovery course for the development of the operated paw. Thank you! Irina

Question: Is it possible to do TPLO surgery and sterilization at the same time?

Hello! Yes, everything can be done at the same time. This does not affect the recovery process in any way.

Hello! The dog had acute renal failure after anesthesia 2 years ago. For two years now, the tests have been normal. The dog is now 8 years old. After each heat, she has severe cramps. The dog has not given birth. Can she be sterilized? What anesthesia is best to use? Now I'm very afraid of anesthesia. Tatiana

Question: is it possible to sterilize a dog if there was acute renal failure after anesthesia?

Hello! Sterilization is indicated. Risks taking into account normal tests no more than in other planned patients. Propofol anesthesia is used.

Cystoscopy for cystitis

Bladder infections are very common cause the appearance of dysuric disorders and other signs characteristic of cystitis in dogs and cats. At acute cystitis endoscopy of the bladder plays a limited role (exceptions are some forms of cystitis, for example, idiopathic cystitis of cats, see photo 1), which cannot be said about chronic cystitis, in which cystoscopy plays a decisive diagnostic and at the same time, often therapeutic role. General endoscopic view mucous membrane in acute or chronic cystitis of moderate severity is reflected in photo 2. In most cases, established diagnoses chronic cystitis The causes of the pathology were polypoid cystitis (see photos 3,4), neoplasia of the bladder or urethra (see photos 5 and 6), as well as urolithiasis.

Endoscopic care for cystitis involves establishing an accurate diagnosis while simultaneously eliminating the cause. chronic infections bladder (biopsy, cytology collection from the mucous membrane, sanitation of the bladder, polypectomy, lithotripsy and stone removal, etc.).

Normal endoscopic picture of the bladder during cystoscopy

Typically, the external urethral sphincter is not visualized as a narrowing of the lumen. The bladder begins to be visualized endoscopically from the moment of dilatation of the proximal urethra. The neck of the bladder is considered to begin from this place. In addition, the urethral mucosa is brighter red. The smooth muscle of the urethra continues continuously into the detrusor of the bladder, which plays a functional role internal sphincter urethra. The entrance to the bladder has the effect of “falling through” into a rounded space with pale pink walls and a pronounced vascular pattern. Almost immediately at the entrance to the bladder there are the orifices of the ureters, which differ from the mucous membrane of the bladder in a slightly paler shade of the mucous membrane of the ureters, from which yellowish urine can be released.

Cystoscopy for bladder stones

Urolithiasis occurs in cats and dogs of both sexes. In males, this pathology most often manifests itself as obstruction of the urethra, in females it manifests itself as signs of cystitis and hematuria. The majority of urolithiasis in cats and dogs is of the struvite type. The crystals of this type of stones are yellowish in color, different shapes and sizes (round, oval, triangular, rectangular). The diagnosis of urolithiasis can be made different ways visual and laboratory diagnostics However, urinary tract endoscopy can be used for both diagnostic and treatment purposes. At established diagnosis urolithiasis, mechanical repair may be performed endoscopic removal stones, crushing them mechanically, electrohydraulically and laser methods. The removal of crushed stones from the bladder is carried out using special baskets, or small uroliths can then be released naturally.

The video demonstrates one of the stages of endoscopic removal of stones from the bladder. The stones are captured by the basket; during the process of removal through the urethra, difficulties arose in that the diameter of the captured conglomerates is slightly larger than the lumen of the urethra. Using a lithotripter, the stones are crushed directly in the basket and then removed.

Normal endoscopic picture of the bladder during cystoscopy

Typically, the external urethral sphincter is not visualized as a narrowing of the lumen. The bladder begins to be visualized endoscopically from the moment of dilatation of the proximal urethra. The neck of the bladder is considered to begin from this place. In addition, the urethral mucosa is brighter red. The smooth muscle of the urethra continues continuously into the detrusor of the bladder, which plays the functional role of the internal urethral sphincter. The entrance to the bladder has the effect of “falling through” into a rounded space with pale pink walls and a pronounced vascular pattern. Almost immediately at the entrance to the bladder there are the mouths of the ureters, which differ from the mucous membrane of the bladder in a slightly paler shade of the mucous membrane of the ureters, from which yellowish urine can be released.

Cystoscopy for bladder tumors

Normal endoscopic picture of the bladder during cystoscopy

Typically, the external urethral sphincter is not visualized as a narrowing of the lumen. The bladder begins to be visualized endoscopically from the moment of dilatation of the proximal urethra. The neck of the bladder is considered to begin from this place. In addition, the urethral mucosa is brighter red. The smooth muscle of the urethra continues continuously into the detrusor of the bladder, which plays the functional role of the internal urethral sphincter. The entrance to the bladder has the effect of “falling through” into a rounded space with pale pink walls and a pronounced vascular pattern. Almost immediately at the entrance to the bladder there are the mouths of the ureters, which differ from the mucous membrane of the bladder in a slightly paler shade of the mucous membrane of the ureters, from which yellowish urine can be released.

Diagnostic cystoscopy

Endoscopy of the urethra (urethroscopy)

Diagnostic ureteroscopy

When performing urethroscopy with diagnostic purpose An important step is to use a uropomp. It is used to ensure that the collapsed walls of the urethra are straightened during examination and the urethra is accessible for visualization. The pressure is created about 2-3 mm. Hg Special attention is given to preliminary emptying of the bladder if a pressure controller in the urinary tract is not used. In males, females and cats of almost any size, this procedure is available without any particular difficulties, which is difficult in cats if they have not previously undergone urethrostomy.
When examining the urethra, pay attention to its mucous membrane, which is normally light Pink colour with characteristic longitudinal whitish stripes formed by the structural features of the distal mucosa of the urethra. During urethroscopy, attention is paid to the uniformity of the lumen of the urethra, the absence of pathological deposits on the mucous membrane, and visible bleeding. The urethra is examined up to the neck of the bladder, which is differentiated as a smooth expansion of the lumen. The transprostatic part of the urethra in males can be narrowed due to compression by the prostate; its color can also differ from the rest of the urethral mucosa in the dark pink direction.

Normal endoscopic appearance of the urethra and vagina

The position on the table is chosen on the left or right side of the patient. Despite the large differences in size (dogs and cats), the main anatomical landmarks during urethroscopy are the same. The caudal portion of the urethra in bitches and cats opens with the urethral orifice in the vulva area along the ventral wall of the vagina at the end of the vestibule directly opposite the angle formed by the dorsal wall of the vagina. By opening the vulva of bitches and cats, we visualize the entrance to urinary system And reproductive system. The normal vaginal mucosa is slightly pink with slight vascularity. Some bitches have initial examination You can see vestibulovaginal stenosis, which may not manifest itself clinically. Bitches may have longitudinal folds varying degrees severity depending on the stage of estrus, however, the dorsal fold of the vagina is always differentiated (see photo). Sometimes, when entering the vagina of a cat or dog, you can distinguish the place of the urethral opening by the flow of yellowish urine. When entering the urethra of bitches and cats with an endoscope, you can immediately distinguish changes in the color and structure of the mucous membrane (see photo). The color of the urethral mucosa is pinkish, and the surface is smoother. When passing the distal part of the urethra with a rigid endoscope, pay attention to the uniform straightening of the possibly collapsed (often stuck together) wall of any part of the urethra. Uniform expansion is possible only with a constant supply of fluid through the working channel of the endoscope. In small bitches, the urethral sphincter is poorly visible (in cats it is not always visualized). When entering the bladder, a visual “abyss” effect is noted, while the walls of the bladder can be clearly seen by passing the endoscope deeper or turning it slightly in any direction. Urethroscopy of male dogs is possible using the appropriate diameter of a flexible endoscope. Urethroscopy of cats is possible mainly in individuals who have undergone urethrostomy.

Urethroscopy for urolithiasis and acute urethral obstruction with urinary stones

Urolithiasis occurs in cats and dogs of both sexes. In males, this pathology most often manifests itself as obstruction of the urethra, in females it manifests itself as signs of cystitis and hematuria. The majority of cystitis in cats and dogs is of the struvite type. The crystals of this type of urolithiasis are yellowish in color, of different shapes and sizes (round, oval, triangular, rectangular). The diagnosis of urolithiasis can be established by various visual and laboratory diagnostic methods, however, urinary tract endoscopy can be used for both diagnostic and treatment purposes. If a diagnosis of urolithiasis is established, mechanical endoscopic removal of stones can be carried out, crushing them mechanically, electrohydraulically and laser methods.

Normal endoscopic appearance of the urethra and vagina

The position on the table is chosen on the left or right side of the patient. Despite the large differences in size (dogs and cats), the main anatomical landmarks during urethroscopy are the same. The caudal portion of the urethra in bitches and cats opens with the urethral orifice in the vulva area along the ventral wall of the vagina at the end of the vestibule directly opposite the angle formed by the dorsal wall of the vagina. By opening the vulva of bitches and cats, we visualize the entrance to the urinary and reproductive systems. The normal vaginal mucosa is slightly pink with slight vascularity. In some bitches, during the initial examination, vestibulovaginal stenosis can be seen, which may not manifest itself clinically. Longitudinal folds in bitches can be of varying degrees of severity depending on the stage of estrus, but the dorsal fold of the vagina is always differentiated (see photo). Sometimes, when entering the vagina of a cat or dog, you can distinguish the place of the urethral opening by the flow of yellowish urine. When entering the urethra of bitches and cats with an endoscope, you can immediately distinguish changes in the color and structure of the mucous membrane (see photo). The color of the urethral mucosa is pinkish, and the surface is smoother. When passing the distal part of the urethra with a rigid endoscope, pay attention to the uniform straightening of the possibly collapsed (often stuck together) wall of any part of the urethra. Uniform expansion is possible only with a constant supply of fluid through the working channel of the endoscope. In small bitches, the urethral sphincter is poorly visible (in cats it is not always visualized). When entering the bladder, a visual “abyss” effect is noted, while the walls of the bladder can be clearly seen by passing the endoscope deeper or turning it slightly in any direction. Urethroscopy of male dogs is possible using the appropriate diameter of a flexible endoscope. Urethroscopy of cats is possible mainly in individuals who have undergone urethrostomy.

For neoplasia of the urethra

Urethral neoplasia is manifested in dogs by blood discharge from the vagina or penis, and dysuric disorders. This type of pathology manifests itself in the form of urethral carcinomas at different stages of development. Chest radiography can detect metastases from carcinoma. In rare cases of polyps of the urethral mucosa, as with carcinomas, transurethral resection and sometimes biopsy are indicated. The so-called granulomatous urethritis, which may be a precancerous process, requires endoscopic morphological identification.

Normal endoscopic appearance of the urethra and vagina

The position on the table is chosen on the left or right side of the patient. Despite the large differences in size (dogs and cats), the main anatomical landmarks during urethroscopy are the same. The caudal portion of the urethra in bitches and cats opens with the urethral orifice in the vulva area along the ventral wall of the vagina at the end of the vestibule directly opposite the angle formed by the dorsal wall of the vagina. By opening the vulva of bitches and cats, we visualize the entrance to the urinary and reproductive systems. The normal vaginal mucosa is slightly pink with slight vascularity. In some bitches, during the initial examination, vestibulovaginal stenosis can be seen, which may not manifest itself clinically. Longitudinal folds in bitches can be of varying degrees of severity depending on the stage of estrus, but the dorsal fold of the vagina is always differentiated (see photo). Sometimes, when entering the vagina of a cat or dog, you can distinguish the place of the urethral opening by the flow of yellowish urine. When entering the urethra of bitches and cats with an endoscope, you can immediately distinguish changes in the color and structure of the mucous membrane (see photo). The color of the urethral mucosa is pinkish, and the surface is smoother. When passing the distal part of the urethra with a rigid endoscope, pay attention to the uniform straightening of the possibly collapsed (often stuck together) wall of any part of the urethra. Uniform expansion is possible only with a constant supply of fluid through the working channel of the endoscope. In small bitches, the urethral sphincter is poorly visible (in cats it is not always visualized). When entering the bladder, a visual “abyss” effect is noted, while the walls of the bladder can be clearly seen by passing the endoscope deeper or turning it slightly in any direction. Urethroscopy of male dogs is possible using the appropriate diameter of a flexible endoscope. Urethroscopy of cats is possible mainly in individuals who have undergone urethrostomy.

Urethral sphincter insufficiency

Sphincter insufficiency is a multi-cause pathology. It occurs more often in female dogs than in males and cats. In adults, it may be a special acquired pathology in sterilized bitches or congenital disease. Although urethral sphincter insufficiency is often associated with a short urethra and intrapelvic bladder neck, sometimes this type of pathology is not associated with anatomical abnormalities. In these cases, endoscopic urethroscopy can provide a lot of valuable information, but retrograde radiographic vaginal urethrography is advisable. In cases where sphincter insufficiency is associated with the lack of endogenous estrogens, endoscopic diagnosis is reduced to visualization of the relative absence of folding of the urethral mucosa (although this endoscopic sign is not pathognomaniac). In some cases, sphincter insufficiency is associated with dilatation of the urethra (more common in males than in females) or with the so-called “urovagina”, in which the vestibule of the vagina and urethra are united. Also, sphincter insufficiency may be associated with exacerbation of urinary tract infections and obesity.

Normal endoscopic appearance of the urethra and vagina

The position on the table is chosen on the left or right side of the patient. Despite the large differences in size (dogs and cats), the main anatomical landmarks during urethroscopy are the same. The caudal portion of the urethra in bitches and cats opens with the urethral orifice in the vulva area along the ventral wall of the vagina at the end of the vestibule directly opposite the angle formed by the dorsal wall of the vagina. By opening the vulva of bitches and cats, we visualize the entrance to the urinary and reproductive systems. The normal vaginal mucosa is slightly pink with slight vascularity. In some bitches, during the initial examination, vestibulovaginal stenosis can be seen, which may not manifest itself clinically. Longitudinal folds in bitches can be of varying degrees of severity depending on the stage of estrus, but the dorsal fold of the vagina is always differentiated (see photo). Sometimes, when entering the vagina of a cat or dog, you can distinguish the place of the urethral opening by the flow of yellowish urine. When entering the urethra of bitches and cats with an endoscope, you can immediately distinguish changes in the color and structure of the mucous membrane (see photo). The color of the urethral mucosa is pinkish, and the surface is smoother. When passing the distal part of the urethra with a rigid endoscope, pay attention to the uniform straightening of the possibly collapsed (often stuck together) wall of any part of the urethra. Uniform expansion is possible only with a constant supply of fluid through the working channel of the endoscope. In small bitches, the urethral sphincter is poorly visible (in cats it is not always visualized). When entering the bladder, a visual “abyss” effect is noted, while the walls of the bladder can be clearly seen by passing the endoscope deeper or turning it slightly in any direction. Urethroscopy of male dogs is possible using the appropriate diameter of a flexible endoscope. Urethroscopy of cats is possible mainly in individuals who have undergone urethrostomy.

For prostate pathologies

Prostate diseases are more common in adult males. But diagnosing prostate disease solely endoscopically is impossible. Often prostate carcinoma is accompanied by proliferative growths visible endoscopically in the transprostatic part of the urethra. In this case, a biopsy of tumor growths is possible. The diagnosis of prostate diseases is based on a combination of retrograde urethrography, biopsy and ultrasound of pathological growths.

Indications

- dysuria
- urethral obstruction
- strangury
- stones in the renal pelvis, detected by ultrasound diagnostics
- hematuria
- urethral tenesmus
— endoscopic treatment of pathologies of the urethral sphincter
- ectopic urethra
- urolithiasis
- urethral neoplasms
— for endoscopic installation of cystostomy
— as assisted operations for laparoscopy
- for biopsy of pathologies of the urethra, bladder, ureters