Today's Veterinary Practice

JUL-AUG 2014

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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July/August 2014 Today's Veterinary Practice 43 PRACTICAL TECHNIQUES Peer reviewed PRACTICAL TECHNIQUES FROM THE NAVC INSTITUTE Feline Perineal Urethrostomy ventral aPProach Clara S.S. Goh, BVSc, MS, Diplomate ACVS, and Howard B. Seim III, DVM, Diplomate ACVS Colorado State University O ver the past decade, advances in the medical management of feline lower urinary tract disease (FLUTD) have decreased the requirement for surgical intervention of the blocked male cat. Perineal urethrostomy (PU) is still the surgical treatment of choice for pa- tients with: • Repeated urethral obstruction despite medical management • Obstruction that cannot be relieved by urethral catheterization • Catheterization that has resulted in significant urethral trauma and/or stenosis. 1 INITIAL MEDICAL MANAGEMENT Prior to anesthesia for an elective PU, manage the patient medically with IV fluid therapy and bladder decompression (via retropulsion of urethral crys- tal/mucus plugs or calculi, catheterization, repeat cystocentesis, or a tempo- rary cystostomy tube) until all renal, metabolic, and electrolyte parameters are within normal limits. FELINE PERINEAL URETHROSTOMY (DORSAL RECUMBENCY) Our preferred technique is a slight variation on the traditional PU described by Wilson and Harrison in 1971. 2 In this variation, the cat is placed in dorsal recumbency instead of the standard perineal approach. This positioning is more ergonomic for the surgeon, and allows access to the ventral abdomen for concurrent cystotomy if indicated. The Essentials for Perineal Urethrostomy • Standard general surgery pack, including needle holders, thumb forceps (preferably Debakey forceps), mosquito forceps, scalpel handle, Metzenbaum and Mayo scissors • Stevens tenotomy scissors (4" straight) • 2 Gelpi retractors (3.5" size) • Suture (4-0 to 5-0 monofilament synthetic absorbable, on a taper or taper-cut needle) • Suction device and small Frasier suction tip W elcome to the first article in our new Practical Techniques from the NAVC Institute column. Each year, the NAVC Institute takes place in Orlando, Florida, and specialists in select areas of veterinary medicine provide hands-on, one-on-one continuing education to the Institute attendees. The NAVC and Today's Veterinary Practice have partnered together to present information from the NAVC Institute 2014 courses. For those unable to attend, this column provides the opportunity to experience the excellent education provided at the Institute. Visit institute for further information. Feline Friendly Article

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