In the other procedure, stay sutures are placed in the mucosa of the prolapsed portion of the urethra to facilitate manipulation.
After inserting a sterile catheter into the urethral lumen, an incision is made approximately 0.5 cm caudal to the prolapsed
portion of the urethra and completely encircling the penis. The initial incision is carried down to the urethral mucosa. After
dissecting penile tissue away from the urethral mucosa, the ventral portion of the mucosa is incised halfway around its circumference.
By incising only half the urethral circumference, stay sutures are not required to prevent the mucosa from retracting back
into the penis.
After ventral portions of the urethral mucosa are sutured to the external surface of the penis with 5-0 to 6-0 Monocryl absorbable
suture, the remaining portion of the urethra is excised and reunited with the penis. A "purse-string" effect can be prevented
by using care not to pull the suture material too tight during closure.
Laser surgery may reduce hemorrhage during amputation of the prolapsed urethral mucosa, and thereby improve visualization
of the operative site. It may also reduce post-operative pain and swelling. An Elizabethan collar may be used to prevent licking-induced
trauma to the anastomosis site.
Appropriate antibiotics should be given if urethritis is associated with the prolapse. Varying degrees of hematuria, especially
during micturition, often occur for approximately one week following surgery.
What type of therapy was selected for the 3-year-old Bulldog?
Because of significant respiratory difficulties associated with stenotic nares and an elongated soft palate, and because of
the episodic occurrence of hematuria, the owner elected a wait and watch therapeutic strategy of benign neglect. During a
four-year span from the date of diagnosis, the urethral prolapse was not associated with any clinical signs. It did not change
in size, shape or color. Unfortunately the dog died of dilated cardiomyopathy, ending our opportunity to further evaluate
Dr. Osborne, a diplomate of the American College of Veterinary Internal Medicine, is professor of medicine in the Department
of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota.