13岁吉娃娃膀胱梗阻患者的尿道造口术和绝育术

Sep 22, 2015. Hari Raya Haji. This Chihuahua has heart and kidney and prostatic enlargement. The first vet advised surgery but the 13-year-old dog may die on the operating table. The owners did not want any surgery. The first vet inserted a needle to suck out 15 ml of lthe urine. But the dog still cannot pee and the bladder ballooned to the size of the mango. The brother who worked in my Toa Payoh Industrial Park area referred the sister to me.

X rays from the first vet shows 2 large bladder stones and one large stone behind the os penis. As the dog is old and in poor health, i did not open up the bladder to remove the bladder stones. The anasethesia will be protracted and the dog's heart may fail.

So, I opened up the urethra behind the os penis and removed the stone of 4 mm diameter. This surgery already takes half an hour but the dog has survived and that is what counts for the owner. The surgery is either urethrotomy (open up the urethra, remove the stone and let is close by itself but the danger is that the whole urethral wound becomes closed up and the dog cannot pee.

So, I did a urethrostomy which is to create a urethral opening by opening the sides of the urethra and stitching the sides to the skin. In this Chihuahua, the urethral diameter is 1.3 mm and so is very narrow. It was not possible to stitch the sides. I inserted the cat catheter for the next 10 days and let the surrounding tissues granulate and heal before removing the cathether.

The prostate enlargement will cause urethral obstruction too. This dog was neutered 2 days ago by Dr Daniel and is now alive. The owner consented to a blood test which showed high urea and creatinine levels.

The urethra is only 1.3 mm in diameter and so I have inserted the catheter for the past 7 days to ensure that the urethral opening is not closed up by the surrounding wound tissue.




The dog was neutered by Dr Daniel 2 days ago and is fortunately alive in this 2nd operation. Neutering will remove the male hormones enlarging the prostate and do away with Tardak injections by the first vet once or twice a week.

The owner consented to a blood test which showed high urea and creatinine levels. So the kidney disease is still present. The first vet adivsed twice a week 250-ml Hartmann's solution SC and so this needs to be done to prolong the life of the dog.

"You stil feed the dog a hamburger every day," I told the brother. "People with kidney failure need to be on a kidney diet to prevent overloading the kidney.and shutting it down."

                               
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The dog will not eat the prescription KD diet because the owner did not persevere by giving small amounts with the hamburger till 100% of KD diet is eaten some 2-3 weeks later.