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Today's Veterinary Practice July/August 2014 46 | PRACTICAL TECHNIQUES tvpjournal.com 5 Use the transected and iso- lated retractor penis muscle as a guide for continued careful dorsal dissection in the same tissue plane, which exposes the urethra to the level of the paired bulbourethral glands. Dorsal dissection is complete once the paired bulbourethral glands (B) are identified dorsolateral to the transected ischio- cavernosus muscles (asterisks). Do not carry out any further dorsal peri-penile dissection once these glands are visualized. SURGICAL INSIGHT: URETHROTOMY INCISION » Make sure the urethrotomy in- cision is on the dorsal midline and is carried out to the level of the bulbourethral glands (ie, the widest point of the penile urethra). » Identify this junction by a vis- ible pale line in the urethral mu- cosa at the level of the bulbo- urethral glands (white arrow). » If the urethrotomy is not carried far enough, the urethrostomy lumen will be too narrow. » If the urethrotomy is carried too far, there will be excessive tension on the PU site. » The ideal urethrostomy site lies 2 to 3 mm proximal to the penile urethra within the wider membranous urethra. SURGICAL INSIGHT: BULBOURETHRAL GLANDS » The transected paired ischiocavernosus muscles are sometimes misidentified as the bulbourethral glands. » These paired glands typically lie adjacent and just prox- imal to the transected muscles, lending a "butterfly" appearance to the penis and surrounding structures. » Identify these glands because they serve as key land- marks for the junction of the more narrow penile urethra and wider membranous pelvic urethra. 6 Transect the scrotal and preputial skin to expose the tip of the penis (A), and remove the urethral catheter. Use Stevens tenotomy scissors to make a longitudinal incision into the urethral lumen, starting distally and continuing on the dorsal midline to the level of the bulbourethral glands (B, white arrow). See Surgical Insights: Bulbourethral Glands and Urethrotomy Incision . 6B 6A Cranial Caudal Cranial Caudal 7 If the urethrostomy opening is thought of as a clock face (with the dorsal aspect pointing toward the anus at 6 o'clock), the most critical sutures are at the 6, 4, and 8 o'clock positions. The 4 o'clock and 8 o'clock interrupted sutures are placed first, leaving the suture ends long as stay sutures to aid in retraction of the tissues. 7 Cranial Caudal Dorsal 5 Cranial Caudal