Urology HOW TO REMOVE URETHRAL OBSTRUCTION IN CATS Figure 5. Sacrococcygeal epidural in a male cat with UO assisted by a neurostimulator device. Video 2. Penis massage in a cat with blocked urethra. With this maneuver it was possible remove a urethral plug lodged in the penile urethra. Video 1. Sacrococcygeal epidural in a cat with UO with assistance by neurostimulator device. Initial maneuvers to relieve the UO Once the patient is relaxed, it is placed in dorsal decubitus. In some cases, it may be necessary to cranially stretch the pelvic limbs in order to expose the perineal region and be able to inspect the prepuce and penis more easily. The penis is exposed and a gentle massage is performed, exerting a slight pressure with gentle rotations with your fingers, by which it is possible to extract the urethral plug or sand, especially if they are near the external urethral orifice (Video 2); this maneuver should be avoided when there are evident uroliths blocking the urethra. A gentle bladder compression should be tried, to induce urination with very little resistance; aggressive compression should be avoided if there is any difficulty in emptying. In many cases, these maneuvers clear the UO and make it unnecessary to place a urethral catheter; however, hospitalization of the patient for medical observation and management is advisable, with 8, 12 or 24 hours of dexmedetomidine (0.0025–0.02 mg/ kg c/8 hours VO) and buprenorphine (0.01–0.02 mg/kg c/8 hours VO); with acepromazine(2.5 mg total c/8 hours VO) in cases of very nervous cats (modified from Coopers et al., 2010). It is worth mentioning that some animals may present a greater sedative effect, so the dose should be adjusted. When the patient manages to urinate without difficulty during the first 24 hours, it can be discharged. When it is not possible to relieve the UO with penile massage it is necessary to place a urethral catheter. Types of urethral catheter The urethral catheterization procedure consists of two maneuvers: first, release the UO; and the second, to place the urethral catheter. Each process requires different material (Table 1) (Figure 6). Table 1. Material to release UO and for the urethral catheterization pro- cedure in the cat. Asepsis and antisepsis • Shaver • Disinfectant solution (chlorhexidine) • Sterile gloves Urethral catheters • Flexible, 3.5 Fr x 10, 14 or 18 cm •polytetrafluoroethylene (Teflon) •polyethylene with or without barium • Semi-rigid •polypropylene UO release Other • Water-based sterile lu- • Needle holder and scissors bricating gel • Nylon suture (2–0 or 3–0) • Olive-tip catheter (Min- • Sterile urine collection bag nesota catheter) – 21 G x 1/2, 1, or 1 1/2” • 3-, 5- and 10 mL syrin- ges • Venoclysis extensions • 23 G needles • Saline solution Figure 6. Material to release UO, and urethral catheterization procedure in the cat. 4 REMEVET
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