Canis ISSN: 2398-2942

Urethra: retrograde urohydropulsion

Synonym(s): Retrograde flushing

Contributor(s): Aidan B McAlinden

Introduction

  • Retrograde urohydropulsion is defined as the use of a catheter and sterile fluid/lubricant to relieve urethral obstruction, by gently propelling uroliths from the urethra back into the bladder under pressure.
  • Correctly performed this can lead to successful resolution of urethral obstruction in the vast majority of cases Urethra: obstruction.

Management

  • The priority of any urethral obstruction should be to correct the metabolic anomalies and stabilize the animal prior to definitive management.
    • Identify and correct acid/base, and electrolyte abnormalites.
    • Establish diuresis.
    • Drain the bladder by cystocentesis Cystocentesis. This will decompress the kidneys, establish renal diuresis and help avoid over-stretching of the detrusor muscle and bladder atony.
    • In cases with obstructive urethral urolithiasis, initially attempt conservative management by catheterization or retrograde urohydropulsion to flush the urolith(s) back into the bladder.
    • Progress to cystotomy Cystotomy to retrieve urolith(s) from the bladder.
    • Place a temporary cystostomy tube Cystostomy: tube if catheterization is not possible or if definitive treatment is delayed, eg whilst undertaking stablization, in preference to repeated cystocentesis, as the latter will predispose to urine leakage and secondary uroabdomen.
    • A minimally invasive inguinal approach for tube cystostomy has recently been described and can be useful in unstable patients as it is less invasive, rapid and can often be performed under sedation in sick patients.

Uses

Advantages

  • May be possible to perform without anesthesia (thus permitting stabilization before surgery).
  • If successful, combined urohydropulsion and cystotomy Cystotomy may allow management of these cases without the risks associated with urethrotomy/urethrostomy Urethrotomy Urethrostomy.

Disadvantages

  • May not be possible to move obstruction in all cases.
  • Potential to cause iatrogenic trauma/rupture to the urethra with poor technique Urethra: rupture.
  • Potential stricture development.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good if obstruction relieved promptly.
  • Risk of complications, eg stricture formation or bladder atony increases with chronic obstructions.

Further Reading

Publications

Refereed papers


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