2. Examination and Diagnosis

1. Clinical examination

The cat was depressed and full of abdominal distention by inspection. The bladder is full of urine. Urinary catheter insertion was blocked and artificial catheterization was not possible.

2. Laboratory examination

X-ray examination was performed after manual restraint, and there were urethra and bladder stones.

3. Diagnosis

Bladder and urethral calculi caused the cat's urethral obstruction, and surgical treatment is recommended.

3. Ureterostomy treatment process

1. Restraint and anesthesia

Abdominal restraint, caudal anteversion and spine Fixed in parallel, an oval object with a size of 15 cm is placed on the back of the abdomen, so that the cat is in a low-front and high-back posture, and the perineum is fully exposed. Clean up the rectal feces and stuff a cotton ball into the anus. The surgical department was shaved and disinfected, and the wounds were isolated. General anesthesia, first intramuscular injection of atropine 0. 2 mg, Sutai 50 induced anesthesia, connected to a respiratory anesthesia machine.

2. Surgical method

On the line connecting the foreskin to the anus, make an arc-shaped incision along the base of the scrotum to the lower end of the foreskin at the upper point 1.5 cm away from the anus. The opposite side is cut in the same way. The skin and subcutaneous tissue are separated along the incision line and then excised to fully expose the penis and testis. Double ligation and cutting of the spermatic cord were performed at a distance of 1 cm to 1.5 cm from the testis, and the total sheath and testis were removed. The penis retractor muscle on the penis is separated and removed, the penis is pulled backward, and the sciatic cavernous muscle and ischiourethral muscle attached to both sides of the penis are cut off at the anal sphincter, so that the penis is completely free. Urethrostomy. Use tissue forceps to clamp the head of the penis, straighten the penis and insert the catheter, use ophthalmic scissors to cut the urethra from the middle of the urethral opening to the bulbar gland, remove the obstruction in the urethra, and press the bladder moderately by the assistant , to expel urine accumulated in the bladder. Fix the catheter. Insert the medical No. 6 double-lumen catheter into the bladder from the urethral opening of the bulbar gland, and inject 1 mL of normal saline to inflate the water bladder at the head of the catheter. Use absorbable sutures (4-0) to suture the apex of the urethral incision and the apex of the skin incision for the first mucocutaneous suture, and then suture the urethral mucocutaneous nodules on both sides of the first stitch. The stitches are about 3 mm apart. After 6 to 7 stitches of side suture, a button-shaped suture is made on the attachment part of the penis and the foreskin, and the penis is transected. Silk knots are sutured to the excess skin. Apply iodine tincture and erythromycin ointment, then connect the urine bag.

IV. Postoperative Care

To prevent the hair from entering the urethra and affecting wound healing, a tail bandage should be applied. After the operation, the patients were continuously rehydrated for 5 to 7 d. Urinary catheter and urine bag were removed 4 days after operation; sutures were removed 10 days after operation. To protect the urinary catheter from breaking, put a dressing on the affected cat, hide the urinary catheter in the dressing, and fix the external urine bag on the back. The urethral opening was washed twice a day with normal saline containing antibiotics, and erythromycin ointment was applied. To prevent cats from licking and biting wounds, wear an Elizabethan collar. Ration of feline urinary tract disease prescription food.

V. Discussion and Summary

The male cat's urethra is thin and long, with two obvious narrow parts. One is in the bulbourethral gland and the other is in the back of the penis. Obstruction of the urethra occurs at both sites. Causes of cat urethral obstruction include infectious factors, such as urinary tract infection with Staphylococcus saprophyticus, Streptococcus, Enterococcus, Pseudomonas, Escherichia coli, Staphylococcus aureus, Proteus; urethral mucosal damage caused by various factors Or urethral rupture; secondary urethral bladder stones, unscientific homemade cat diet is the main factor causing stones. Cats with lower urinary tract obstruction often present with frequent urination, dripping urine, blood in the urine, urinary retention and distress, with a hyper-filled bladder. Sometimes, although dredging and flushing through the urethra can relieve the symptoms, but the recurrent attacks cannot be completely cured, and surgical treatment is the only option. Urethral orifice reconstruction is the best treatment option for cases of complete urinary tract obstruction. Urethrostomy is an effective measure for the treatment of intractable urethral obstruction in male cats, and perineal urethrostomy is a more commonly used and effective ostomy method. For cats with poor general condition and uremia symptoms such as loss of appetite and vomiting, acidosis should be corrected in time, the balance of body fluids and electrolytes should be adjusted, and fluids should be replenished before surgery. When the bladder is emptied during surgery, fluids should be given immediately. When suturing, the local wound should be repaired first, so that the incision of the skin is larger than the incision of the urethra, so as to avoid varus caused by too much skin. When sutured, the mucous membrane should wrap the skin, and the mucous membrane should not be wrapped by the skin. The mucous membrane should be closely aligned, and the suture should not be too tight to ensure that the suture does not turn in, turn out, or fold. Postoperative care is very important. Careful care should be taken after the operation to prevent the cat from biting off or tearing off the urine tube or bag, causing a series of sequelae. Sufficient water should be given to the cat after surgery, and a prescription cat food to prevent stone formation should be given. Care should be taken to remove foreign bodies and blood clots from the urethral orifice to ensure the free discharge of urine through the artificial urethral orifice. And pay attention to keep the local dry, in order to facilitate wound healing.