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.

Roboroskvi's black lump - strangulated testicle?

This dwarf hamster bit me and Alice, a 4th-year vet student seeing practice at Toa Payoh Vets in Jan 2010. The Roboroskvi did not mind being handled but got fed up of being handled to be examined so many times. He bit my finger as I checked on him post-operation. Sharp incisor teeth. There was no blood at first. Suddenly the dam burst and I had to wash the blood off my finger. I asked Alice if she had been bitten. She said "Yes".

This high-speed Roboroskvi was 9 months old. His lady owner brought him in for a consultation as she saw this blackish lump in the lower groin area on the right side. A rather big black lump of 8mm x 4mm appeared on the right inguinal area. What was it? Was it a gangrenous testicle? How did it appear? What to do now?

There was no on the other side. Surgery to remove the lump was the only option.

Zoletil 50 given IM. Growth removed. Skin wound of 6 cm long was stitched with 5/0 absorbable sutures. Hamster was OK and I sent him home to a happy lady owner. I did not send the lump for histopathology as that meant the owner had to pay more. There was considerable bleeding on excision of the growth. Unlike dogs, it would be difficult to clamp below the growth in this hamster. Fine ophthalmic forceps could be used to clamp but there was little space. In any case, this hamster survived.
For hamsters with growths, there is no justification to give antibiotics and hope they will disappear. The vet has to use his or her good judgment as regards ethics and the economics of the practice. Vets must be careful as there may be negligence litigation/complaints if the hamster with an obvious growing tumour is treated with just drugs, powder and some homeopathic/herbal medication.









If the vet does not want to do hamster surgery, it is best to ask the owner to go elsewhere rather than just prescribing some drugs. In this case, a strangulated testicle or gangrenous lump may rot, become infected or ulcerated and kill the hamster after some weeks.

P.S. Examine speedy dwarf hamsters like the Roboroskvi above a big bowl so that the hamster will drop onto the bowl if they escape your grasp. On the examination table, they may sprint away before the vet assistant or nurse could react and fall off the table!




Update and more pictures at: www.toapayohvets.com

40. Electro-surgery in a dwarf hamster

E-MAIL TO DR SING
Jan 8, 2010

Subject: For Doctor Sing (Enquiries on Dwarf Hamster - Ear Irritation)
To: judy@toapayohvets.com
Date: Friday, January 8, 2010, 2:58 PM

Dear Doctor Sing,

Happy New Year to you & I hope this email finds you well...

I would like to seek your advice on one of my dwarf hamster. She's currently 1.5yrs old and had been in good health all these while.. Just 2 days ago, i notice that she is excessively scratching her right ear & it became obvious that the outer ear area turns red and slightly sore...

Few months back my other male dwarf hamster (Name) had ear infection as the bathing sand and bedding went into his ear, he recovered after treated by you in Oct 2009. I've since then stopped all bathing sand and switched to towel as bedding for all my hamster. I rule out the possibility of mites or mange as their cage are kept clean and i change their towel twice a day.

I wonder if it helps if i were to purchase from your clinic the same medicines (pink & white colour to stop itchness and prevent inflammation if i remembered correctly) to treat this hamster.

I've enclosed pictures of my hamster and I hope the above information is useful.

Looking forward to hearing from you soon.

Thank you so much & wishing you a good weekend ahead :D


Best regards,

Name of Lady Owner


E-MAIL REPLY FROM DR SING was given to the owner. "It is best to examine the hamster as e-mail pictures are not clear. The owner brought the hamster in for consultation and accepted my advice to get the tumour/swelling on the side of the ear removed. It may become infected or grow larger."


E-MAIL REPLY FROM DR SING
Jan 10, 2010
Subject: Re: For Doctor Sing (Enquiries on Dwarf Hamster - Ear Irritation)

Thanks for pictures of the previous hamster I treated. As I don't read email regularly, pl tel me if you need any answers. In any case, your hamster is OK (after electro-surgery). It has the same inflammation of the ear canal as the previous one. Liquid and black particles inside the ear canal were exposed during surgery to remove the lump outside the ear canal. I thought you had used some ear lotion or normal saline.


E-MAIL TO DR SING
Jan 15, 2010
...@hotmail.com> wrote:
Subject: RE: For Doctor Sing (Enquiries on Dwarf Hamster - Ear Irritation)
To: drsing_98@yahoo.com
Date: Friday, January 15, 2010, 3:06 PM

Hi Doctor Sing,

It's been 5 days since i brought my hamster back and have fed her with the required medication on a daily basis. She's eating & exercising normally and looking at her ear, the little wound has dried up but she's rather sensitive whenever i tried to clean or remove the layer of dried skin which is in dark red or black color.

Just to check if i can leave it alone, will the dried layer automatically drop off by itself or will there be a likelihood that she may accidentally push it further into her ear?

Thank you.

Regards,

Name of Lady Owner


E-MAIL REPLY FROM DR SING
Jan 16, 2010

I just returned from overseas. The blood clot is the wound left over when the tumour/swelling in the lateral canal of the ear was removed. It will dry up later and replaced by new skin. Remove it slowly. Remove bit by bit with the smallest cotton bud (dipped in warm water). It is hard to say whether the clot will cause a problem, but I don't think it will.


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