Feline Perineal Urethrostomy: A Review of Past and Present Literature.

Urethral obstruction is a potentially fatal condition and in cases of recurrent obstruction or an identified cause that is refractory to medical management, a urethrostomy may be performed for definitive treatment. Perineal urethrostomy is the surgical creation of a permanent stoma in the wider pelvic urethra via anastomosis to the perineal skin. Diagnosis of the underlying cause of obstruction, proper perioperative treatment, and an understanding of the anatomy and surgical technique, are imperative to the success of this procedure. This review intends to highlight these aspects, as well as the common complications and expected prognosis to aid decision making in the management of these cases.

Laser vaporization of the dorsal turbinate as an alternative method of accessing and evaluating the paranasal sinuses.

OBJECTIVE: To report a technique for stoma creation into the conchofrontal sinus (CFS) through the dorsal turbinate and to evaluate stoma as a site for sinoscopy. STUDY DESIGN: Prospective experimental study. ANIMALS: Cadaveric equine heads (n=2) and normal adult horses (5). METHODS: Technique feasibility was established on 2 cadaver heads. A diode laser fiber with a contact probe was passed into the nasal passage through a custom built, laser introducer rod (LIR). A videoendoscope was passed ventral to the LIR. A site on the caudal, medial aspect of the turbinate overlying the dorsal conchal sinus (DCS) was identified. A stoma to facilitate endoscope passage was created through the turbinate and sinoscopy performed to identify structures within the CFS and caudal maxillary sinus (CMS) and to evaluate the quality of the approach. The procedure was then performed in standing, sedated horses. Time required, laser energy used and complications were recorded. Endoscopy was performed ≥5 weeks postoperatively to assess stoma size and long-term effects of the procedure. RESULTS: A stoma was successfully created through the turbinate in both cadaveric skulls and in 4 horses; the stoma persisted for ≥5 weeks. The location of the stoma in 1 horse precluded sinoscopy. CONCLUSIONS: Laser vaporization of the dorsal turbinate through the nasal passage creates a stoma that lasts for at least 5 weeks providing a portal to the paranasal sinuses. Based on experience in 1 horse stoma location is critical to ensure adequate endoscope manipulation and sinoscopy. CLINICAL RELEVANCE: Standing endoscopic sinusotomy within the nasal cavity through the DCS is an alternative to more invasive sinusotomy techniques with fewer potential complications and a cosmetic result.

Use of a hyaluronate membrane for jejunal anastomosis in horses.

OBJECTIVE: To compare the outcomes of double-layer inverting anastomosis (DIA), single-layer anastomosis (SLA), and single-layer anastomosis combined with a hyaluronate membrane (SLA+HA-membrane) with respect to stomal diameter, adhesion formation, surgery time, and anastomotic healing in horses. ANIMALS: 18 adult horses. PROCEDURE: Midline celiotomy and end-to-end anastomoses were performed. In control horses (n = 6), DIA was performed; in treated horses, SLA was performed (6) or SLA+HA-membrane was performed (6). Horses were euthanatized 21 days after surgery. Abdominal adhesions were evaluated grossly and histologically. Stomal diameters were measured ultrasonographically and compared with adjacent luminal diameters. Anastomotic healing was evaluated histologically for fibrosis and inflammation, tissue alignment, and inversion. Surgery times were recorded for the anastomotic procedure and compared among groups. RESULTS: There were significantly more adhesions in the SLA group, compared with the DIA and SLA+HA-membrane groups. Reduction in stomal diameters in the DIA group was significantly greater than the SLA and SLA+HA-membrane groups. Surgery times for the DIA group were significantly greater than the SLA and SLA+HA-membrane groups. Histologic findings of fibrosis, inflammation, and mucosal healing were similar among groups. There was significant tissue inversion in the DIA group, compared with the 2 treatment groups. Tissue alignment was not different among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Use of a SLA+HA-membrane was an effective small intestinal anastomotic technique. This technique was faster to perform and resulted in a larger stomal diameter, compared with the DIA technique and significantly fewer perianastomotic adhesions, compared with the SLA technique.