How would you manage a prolapsed urethra in an English Bulldog? - DVM
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How would you manage a prolapsed urethra in an English Bulldog?


DVM360 MAGAZINE



Photo 2: The urethral prolapse in the English Bulldog described in Photo 1 taken when he was 5 years old.
Of the Bulldogs with prolapsed urethras treated by surgical excision at the University of Minnesota, varying degrees of urethral prolapse recurred in four dogs one week to 18 months following surgery. In three dogs, further surgery was not performed. In these dogs, the owners observed recurrent episodes of bleeding. One dog was subsequently euthanized because of the owner's concern about episodic bleeding.


Photo 3: A urethral prolapse in the English Bulldog described in Photo 1 taken when he was 7 years old.
What was the biological behavior of the urethral prolapse in this 3-year-old Bulldog? During a four-year span from the date of diagnosis, the dog was evaluated at approximately four-to six-month intervals. The urethral prolapse was not associated with any clinical signs: it did not change in size, shape or color (Photos 2-3). Unfortunately the dog died of dilated cardiomyopathy, ending our opportunity to further evaluate this disorder. However, contrary to many textbook descriptions, the clinical course of this patient with a urethral prolapse indicates that surgery is not always necessary. This point may be especially relevant to patients (like this Bulldog) who are poor anesthetic risks.

Management types

What types of management would you consider?

If our hypothesis is valid that increased intra-abdominal pressure is a risk factor for urethral prolapse in dogs predisposed to this abnormality, consideration should be given to minimizing problems that cause increases in intra-abdominal pressure.

This may include eliminating underlying causes of dysuria, castration to minimize sexual activity, and correction of stenotic nares and/or elongated soft palates. We emphasize that these recommendations have not been validated by controlled clinical trials.

In situations (as described in this case) where prolapse of the urethra is asymptomatic, or when episodic bleeding is no more than an inconvenience, therapy may not be required. We do not recommend use of glucocorticoids, since they are unlikely to provide any beneficial effect, but are likely to increase the risk for ascending urinary tract infection. If excessive licking contributes to trauma of the prolapsed urethra, Elizabethan collars or similar types of restraint devices may help to break the licking cycle.

If prolapse of the urethra occurs only during erections, consider castration prior to attempting surgical correction. Low doses of diethylstilbestrol given for approximately one month following castration may aid in the reduction of the frequency of erections.

If the urethral prolapse is small, and if further treatment is deemed unnecessary, manual reduction may be considered. Manual reduction of the prolapsed segment is facilitated by use of general anesthesia and a urinary catheter. The catheter should be as large as it can be without causing further damage to the urethra. Alternatively, a Swan-Ganz balloon catheter or a pediatric Foley catheter may be of value in reducing the prolapse. Following correction of the problem, a purse-string suture of non-absorbable monofilament material should be placed at the external urethral orifice. The urinary catheter should then be removed. The purse string suture should be removed in approximately five days. Appropriate antibiotics should be given if bacterial urethritis is a cause or result of the prolapse. The owners should be advised that the urethral prolapse might recur, especially if an underlying predisposing cause has not been identified and eliminated or controlled.

Surgery should be considered for patients with excessive bleeding, pain or extensive ulceration and/or necrosis of the prolapsed tissue. The most commonly recommended type of surgery involves removal of the prolapsed urethral tissue, and suturing of viable urethral mucosa to the external surface of the penis. Two procedures designed to resect the prolapsed portion of the urethra have been described. The primary difference between these procedures is the method used to prevent retraction of the urethral mucosa into the penis after the prolapse is amputated. In one technique, two straight intestinal surgical needles are inserted at right angles to each other, first through the external surface of the penis, then through the non-prolapsed portion of the distal urethral lumen, and finally through the external surface of penis of the opposite side. The prolapsed portion of the urethra is then excised and the remaining edge of the viable urethra is sutured to the external surface of the penis using a simple interrupted pattern (4-0 to 6-0 Monocryl absorbable monofilament suture).


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