42. Urinary stone removal - Urethrostomy or Cystostomy?

URETHOSTOMY METHOD
The surgical approach depends on the vet.
I remember a Chihuahua owner from Toa Payoh some years ago. He preferred an older vet to handle his Chihuahua's urinary stone obstruction behind the os penis after getting a diagnosis from me. Such situations happen to all vets and so I was not offended. The older vet did a urethrostomy behind the os penis. Problem solved. However, the owner did not like the post-operation complications, saying that the dog "leaked urine" all over the apartment after the surgery.

I don't know whether this male dog was urine-marking or not as I did not make further queries. He wanted euthanasia. Vets do urethrosomy if the bladder has no stones. But should the dog continues urine-marking, the urine just "leaks" everywhere.

If there are no stones inside the bladder, most vets will use the urethrostomy method. It is logical. However, in the above case, it had an unhappy ending as the owner got the dog euthanased for dirtying the apartment. Would a cystostomy approach as done below save this Chihuahua's life?







CYSTOSTOMY METHOD
Yorkshire Terrier, Male, 9 years. 3.6 kg 39.4C
Urethral obstruction.
X-rays showed urinary stones in the bladder and behind the os penis.
What is the surgical approach?

30.1.2010
Domitor 0.3ml IV
Isoflurane gas
Antisedan 0.3 ml IM at the end of surgery

IV glucose 200 ml pre-surgery
Hartman Solution IV 2 days post op
Baytril 0.3 ml and Rimadyl 0.2 ml SC

31.1.2010. Ate l can A/D diet. T=38.7 deg C
To flush bladder again. Lots of bleeding and debri

SURGERY on 30.1.2010
Cystotomy only. Used catheter via bladder and via penile urethra to dislodge all stones via flushing many times. No need urethostomy in many cases although on first impression, a urethostomy behind the os penis would seem logical.
Catherised 3 days. Warded.