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Managing lower urinary tract obstruction (Proceedings)

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Aug 01, 2011

The most common cause of urinary obstruction in small animal surgery is urinary stones in the urethra. Other causes of obstruction are neoplasia in the urethra, and neoplasia compressing the urethra. Generally, small cystic calculi migrate to the neck of the bladder during micturition and pass into the urethra. In the male, urethral calculi most commonly lodge caudal to the os penis. In the female, calculi may lodge at any location along the length of the urethra. Urethral obstruction is more common in the male than female.

Urinary obstruction requires medical treatment to stabilize the patient to surgery and surgical treatment to release the obstruction. Dogs and cats with urinary obstruction are presented with hematuria, stranguria, and pollakiuria. Plain radiographs or radiographs with contrast material (excretory radiographs, cystourethrograms) will confirm the presence of a urinary stones or mass in the urethra.

Medical management

Blood work with complete blood count, and biochemistry is required to evaluate kidney function of the patient. Urinary obstruction is associated with severe post renal azotemia and severe electrolytes imbalance. Hyperkalemia is the most common electrolyte abnormality. Hyperkalemia can induce severe bradycardia if the concentration is over 5 mEq/dl. Therefore, it is important to reduce the hyperkalemia before anesthetizing patients with urinary obstruction.

The most efficient technique to lower the potassium concentration is to diaries the patient. If the patient can still urinate on its own intravenous fluid therapy will induce a diuresis. If the patient cannot urinate cystocenthesis can be performed to empty the bladder. The concentration of potassium is monitored very closely to be able to anesthetize the patient as soon as the potassium is back to normal limits. If diuresis is not efficient insuline/glucose and bicarbonate can be used. While the glusoce moves intracellular it brings the potassium in the intracellular space. Potassium and hydrogen particles are exchanged which results in metabolic acidemia. Therefore bicarbonate is required to control the acidosis. This technique lowers the potassium within 30 minutes. If the potassium concentration is not reduced then calcium gluconate is used to protect the myocardium form the effect of potassium.