SURGERY
brim. The bladder is retracted cranially and the ventral
aspect of the urethra is exposed to the level of the cranial
pubic brim. Stay sutures are placed on either side of
the ventral bladder neck and urethra before a ventral
cystourethrotomy is performed in the ventral midline.
Two full-thickness bladder wall slings are harvested from
the left and right sides of the urethral wall. Stay sutures
are placed in the cranial ends of each bladder sling. A 10
FG Foley catheter is inserted into the bladder with its cuff
in the bladder lumen before the narrowed urethral wall is
sutured closed over the Foley catheter that is used as a
stent. (Figure 6)
Once the entire urethra and the neck of the bladder have
been sutured closed, the two urethral wall slings are pulled
underneath the exposed urethra to form a figure-of-eight
pattern around the urethra (Figure 7). The cranial end of
each sling is finally sutured to the ventral bladder neck
area to maintain them in this position (Figure 8). The cuff
of the Foley catheter is inflated and gently pulled caudally
until the cuff lies in the bladder neck. All the stay sutures
are removed and the ventral abdominal wall is closed
routinely.
Figure 6. Two full-thickness urethral wall slings with stay sutures
in their cranial ends are retracted sideways () while the narrowed
urethra is sutured closed over the Fole y® catheter with 4/0 PDS in
a simple continuous suture pattern. (The patient’s head is on top of
the photo)
The Foley catheter is secured to the tail of the bitch and
maintained in place for four to six days to allow resolution
of postoperative urethral swelling. A NSAID is administered
for the first 5 days while the dog is hospitalised. No
antibiotics are given while the indwelling catheter is in
place. After 4 to 6 days the Foley’s catheter cuff is deflated
and the catheter removed. The tip of the catheter can be
used for bacterial culture and antibiotic sensitivity testing
if cystitis is expected.
Most dogs will have some dysuria for a day or two due to
increased outflow resistance. Bethane col (Urecholin®)
with diazepam (Valium®) can be administered for 7 to 10
days to alleviate this. The owner must carefully observe
if the bitch is able to urinate with a stream or if the animal
is showing pollakiuria with only small volumes of urine
during voiding. In 53 dogs operated by myself with this
sling urethroplasty technique over the past decade, 45
animals did not need any additional phenylpropanolamine
or estradiol to maintain urinary continence.
Figure 7. Two stay sutures maintain the two urethral slings that are
forming a figure-of-eight pattern around the urethra that has been
sutured closed with 4/0 PDS. The cranial ends of the slings will
be secured to the ventral bladder neck area with 4/0 PDS simple
interrupted sutures.
4. Polypropylene tape used as an artificial
urethral sling
The first work was published by Stephanie Claeys et al.
(2010) from Belgium 12 . The trans-obturator vaginal tape
inside out (TVT-O) has later been used in 7 incontinent
female dogs with this polypropylene tape that is actually
used for stress incontinence in women and was found
fairly easy to install with good clinical effect 13 .
A median episiotomy is first performed to reach the
urethra and to install the polypropylene tape around the
urethra after an incision has been made into the floor of
the vagina just proximal to the external urethral meatus.
The blue polypropylene tape is covered in a thin plastic
Figure 8. The cranial ends of the slings are secured to the ventral
bladder neck area with 4/0 PDS simple interrupted sutures.
Issue 02 | MAY 2018 | 33