Feline urinary diversion procedures (Proceedings)

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Feline urinary diversion procedures (Proceedings)

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Aug 01, 2010

Urine diversion techniques are performed to temporarily or permanently divert urine from its normal anatomic course from the kidney through the ureter to the bladder and finally through the urethra. Veterinarians are most familiar with temporary urine diversion (urethral catheters) that are often used to stabilize animals that are sick as a result of metabolic changes associated with urinary tract obstruction. Temporary diversion (peritoneal drainage) may also be used as a bridge to more definitive surgical procedures such as repair of a ruptured urinary bladder.

Permanent urinary diversion is performed as a surgical procedure to redirect or reconstruct portions of the urinary tract that have been damaged by trauma or neoplastic involvement or for palliation of recurring urethral obstruction. Most permanent procedures performed in animals have been to circumvent areas of the urethra prone to obstruction with calculi or mucus plugs.

Temporary Diversion

          A. Urethral
          1. Useful for maintaining patency of urethra in obstructed animals, measurement of urine production in animals with renal disease, and as stents to allow uroepithelium to migrate over tears or lacerations to the urethra.
          2. Soft rubber or silicone preferable to polypropylene and should be connected to a "closed" urinary system.
          3. We do NOT routinely administer antibiotics to animals with indwelling catheters (selection for hospital/resistant pathogens) BUT we do urine culture and sensitivity when we remove the catheters.

          B. Prepubic urinary diversion
Tube Cystostomy is an easily performed urinary diversion procedure that allows drainage of urine from animals where indwelling urethral catheters cannot be passed. Has also proven useful as a palliative procedure for those animals with neoplastic disease of the bladder/urethra.

          1. Identical procedure to "feeding tube gastrostomy" tube placement but using the bladder.
          2. Place a purse-string suture in the rostral 13/rd of the ventral bladder wall using absorbable suture.
          3. Make a stab incision in the middle of the purse-string and insert a Foley or Pezzar catheter into the bladder (AFTER passing it through the abdominal wall first) and tighten the purse-string.
          4. Place a "pexy" suture both cranially and caudally between the bladder wall and the abdominal wall using absorbable suture.
          5. Connect the catheter to a closed urinary collection system.