Vesicostomy Secondary to Urethral Rupture in a Dog. Survival of 2 Years
C. Donatti; C.V.S. Brandão; J.J.T. Ranzani; M.G. Sereno; G.T. Angelico; N. Vieira
Rupture of the urethra is most frequently associated with pelvic fractures. Clinical signs of urinary tract trauma are often vague and may be masked by other signs of trauma. The animal may have azotemia, hematuria, dysuria, abdominal pain, abdominal swelling or herniation may be noted. If rupture of the bladder or urethra is suspected radiographs may show reduced size or absence of the urinary bladder, decreased visceral detail, increased size of the retroperitoneal space. A positive contrast cystogram and analysis of abdominal fluid should be performed, where creatinine levels of the abdominal fluid will be greater than those in the blood. A complete blood count and serum biochemical profile should show hyperkalemia and azotemia. The differential diagnosis includes peritonitis or pancreatic, renal, splenic, hepatobiliary or gastrointestinal abnormalities. Urethral trauma may be repaired by primary anastomosis or reimplantation into the bladder. Depending on the location of the damage a vesicostomy is necessary. A dog, poodle, male, 2 years old, was treated at Veterinary Hospital--FMVZ Unesp Botucatu suffering from complete urethral disruption secondary to pelvic fracture since it had been run over four days before. It also suffered from azotemia, abdominal pain, dehydration, and cutaneous urinary fistula. A positive contrast cystogram was carried out with extravasation of contrast to the abdomen as well as an exploratory laparotomy with identification of the bladder. The urethral rupture was located right in the vesical end. After a partial "pubectomy" and the catheterization of the penile urethra, the abdominal urethra was found, which looked necrotic and unable to undergo an anastomosis due to severe chemical peritonitis. Then a ventral abdominal vesicostomy was performed. Postoperatively, metronidazole, cephalexin, trammel, dipyrone and fluid therapy were administered. The vesicostomy was occluded by using a Foley catheter balloon. The animal responded to the treatment well, got rid of the Foley catheter on the third day after the surgery, but the urinary flux remained steady through the vesicostomy. Due to urinary incontinence, the animal was kept in diapers, which were changed three times a day, and did not show any cutaneous trauma. The animal survived for 2 years after the surgery and there was no incidence of bladder lithiasis during that period. The vesicostomy is a surgical technique that proved acceptable to a selected group of animals, since it requires daily care concerning hygiene and change of diapers in order to prevent cystitis, which is recurrent after this kind of procedure.