I am using the Google Docs & Spreadsheets for the first time to document this case. Pictures are at www.toapayohvets.
Be Kind To Pets educational story is to share my veterinary experiences with younger vets in other parts of the world as most veterinary surgical books are too brief on the overall management of the case of a large oval anal wound in a cat.

Jun 26, 2007 3.17 pm

What to do with such a large infected oval wound near the anus? The cat had licked out the fatty tissues under the skin. A big gap of 0.5 cm deep. She had stopped pooping. How to close such a big gap successfully?

1. Ideally, put the cat on antibiotics for a few days. Was the wound. But the wound is large.
2. The cat was fat, at 5.5 kg. Would she be able to survive the injectable general anaesthetic?
3. Anaesthesize the cat using xylazine and ketamine.
4. Clip the hairs, wash the areas. Syringe in 6% hydrogen peroxide.
5. Debride --- cut off dead skin edges and remove dead tissues from inside.
6. Relieve anal sacs of oil. Greyish brown oil seen from left gland. Right gland must have had ruptured resulting in a big hole.
7. Trim edges of wound --- convert to diamond shaped wound.
8. Undermine tissues to get loose skin.
9. Cut lowest end to extend the wound. Z-shaped wounds sutured.
10. Avoid anal sphincter (near the anal ring).
11. Elizabeth collar size 10.
12. Best to ward cat for 10 days but owner wants her home.
13. Warn the owner to confine the cat and if she runs around the home, she may rub stitches off.

14. In 14 days, wound will heal and stitches to be removed.

I am using the Google Docs & Spreadsheets for the first time to document this case. Pictures are at www.toapayohvets.
Be Kind To Pets educational story is to share my veterinary experiences with younger vets in other parts of the world as most veterinary surgical books are too brief on the overall management of the case of urethral and bladder stones surgery.

June 12, 2007

For a veterinarian, it is a happy scene to see a male dog peeing normally within one second of leg lifting on day 6 of the surgery.

At 4 p.m on June 12, 2007 (day 6) after surgery , the Silkie Terrier was taken out from his crate. "He prefers the grass patch to pee," James said. The 8-year-old male dog with urethral and bladder stone removal surgery on June 7, 2007 lifted up his left hind leg and easily peed light yellow urine. Before surgery, he put up his hind leg for over an eternity of several seconds with little or no dark brown urine coming out.

Back to the beginning of the story. On Jun 7, 2007 (day 1), 8% halothane gas. Dog intubated.

Urohydropropulsion - Put dog on sternum. Finger inside rectum to press on urethra. Inject via catheter 20 ml of sterile saline. Release digital pressure. The theory is that the saline will flush the stones into the bladder. Therefore, no need urethral surgery to remove stones. With large stones (seen in X-ray), this procedure was a waste of time. However, I tried it. It was ineffective.

Urethrotomy --- Insert F/8 sterile catheter into urethra. It could not get into the bladder as the stones behind os penis blocks it. At least 4 urethral stones were removed. 2 big stones around 3 mm in diameter blocked urethra behind the os penis (penile bone).
Urethra stitched up with 5/0 interrupted absorbable suture. Skin then stitched up with 3/0 interrupted absorbable suture.

Cystotomy --- 40 ml saline flushed into bladder via catheter to dilute and drain out the dark brown urine. Then more saline to inflate the bladder. I incise 1 cm into the thick bladder wall at its apex, ventral surface. Took the bladder out of the body as much as possible. Thick walled. Big wide red veins on its surface indicating that infection (cystitis) had been present for some months. As I cut the bladder, urine and saline shot out. I made sure that the urine shooting out did not get inside the peritoneal cavity of the dog otherwise there will be peritonitis.

Flushing the bladder of all debri and stones --- I clamped the 1-cm muscle wall of the bladder. My assistant inject another 40 ml of saline via the catheter into the bladder twice. I removed the clamp and let the urine and saline shoot outside the body. The liquid spurted onto the floor and would have splattered onto me if the position of the surgical site was directed at me. All bladder stones and debri should have been flushed out from the 1 cm incision. From the X-ray, the stones could be around 0.6 cm in diameter.

Catherisation --- Not more than 5 days are recommended. On day 1, the catheter was pulled out by the dog from the inside out. The 2 nylon stitches anchoring the outer end of the catheter to the groin skin were intact. "The catheter came out from inside," my veterinary assistant said. The Elizabeth collar had been taken out too and the dog licked the operation areas. Blood plus urine leaked out from the behind the os penis surgical site.

Post-op care very important --- At least 5 days hospitalisation --- Post-operation nursing is very important as the owner seldom knows what to do if the dog is sent home after surgery. In this case, the catheter was pulled out by the dog. A new one was inserted. But it was hard to get it into the bladder as the dog was laid on his side on the operation table. What to do? Anaesthesize the dog with gas. The urethral muscles relaxed and the catheter was inserted. This time, sticky bandaged the catheter tip to the prepuce and wrap the elastoplast bandage around the body.
On day 3, the elastoplast was removed. Some blood plus urine leaked out from the prepuce. The area was cleaned up. A bigger Elizabeth collar was used. The dog was spoon fed with home-cooked food and given water. No dry food.

On day 5, the catheter "dropped off" as the self-adhesive bandage wrapped round the body of the dog was not sufficient to prevent him getting the catheter out. He was observed to pass urine normally. Large red purple areas around his surgery site indicated attempts to lick the whole area. I gave the dog an inflammatory injection. He felt so much better and the redness receded by at least 50% on day 6.

For a veterinarian, it is a happy scene to see a male dog peeing normally within one second of leg lifting on day 6 of the surgery.

At the time of this report, it was 4 p.m on day 6 after surgery , the Silkie Terrier was taken out from his crate. "He prefers the grass patch to pee," James said. The 8-year-old male dog with urethral and bladder stone removal surgery on June 7, 2007 lifted up his left hind leg and easily peed light yellow urine. Before surgery, he put up his hind leg for over an eternity of several seconds with little or no dark brown urine coming out.

Economics --- The total cost of consultation, anaesthesia and 2 surgeries (urethral and bladder) was S$600. X-rays were taken by another veterinary surgery. Blood tests ought to be done but that would add up to the cost. Prescription diet was to be recommended but home-cooked food was more economical.

Owner's permission to talk to the other vet. It is always ethical to get the permission from the owner to talk to the veterinarian who first saw the case. She is an experienced veterinarian who used to be my intern as a 20-year-old who was doing "A" levels at night. A girl who wanted to be a veterinarian. She saw practice for a few months before she went for her foundation studies in Kuala Lumpur and later studied veterinary medicine in Australia. That was at least 15 - 20 years ago. I have no doubt about her competence to do the surgery as she was with a top veterinary practice for some years before setting up her own practice. She was kind enough to share her surgical experiences about urohydropropulsion using lubricant and saline and the surgical procedures.

Pictures are at: www.toapayohvets.com