Urethral mucosa resection and anastomosis is a surgical procedure used to treat a prolapsed urethra in dogs, particularly when there is a prolapse of the urethral mucosa (the lining of the urethra) through the urethral opening or external genitalia.

 

The procedure typically involves:

 

1. Resection of the prolapsed tissue: The prolapsed portion of the urethral mucosa is carefully removed. This can include trimming or excising excess mucosa that has prolapsed through the urethral opening.

 

2. Anastomosis: After resecting the prolapsed tissue, the remaining healthy urethral mucosa is reconnected (anastomosed). This involves suturing the edges of the mucosa together to restore a normal anatomy and allow for proper function of the urethra.

The goal of this surgery is to:  

•Relieve the prolapse and any associated symptoms such as urinary incontinence, straining, or obstruction.

•Restore the normal structure and function of the urethra.

Indications

 

The surgery is typically indicated in cases where:

 

•There is a significant prolapse that is causing clinical symptoms (e.g., difficulty urinating, visible prolapsed tissue, bleeding, or recurrent urinary tract infections).

•Conservative treatments, such as medical management or manual reduction have failed.

•The prolapse is chronic, recurrent, or has caused anatomical changes that require surgical correction.

Risks and Complications

 

As with any surgical procedure, there are inherent risks associated with urethral mucosa resection and anastomosis. These risks include, but are not limited to:

 

1. Anesthesia Risks:

• Like any surgery requiring general anesthesia, there is a risk of adverse reactions to anesthesia, particularly in high-risk or senior dogs.

• Some dogs may have pre-existing conditions (e.g., cardiac, hepatic, or renal disease) that may increase the risk of anesthesia-related complications.

 

2. Infection:

• As with any surgery, there is a risk of infection at the surgical site. The urethra is a sterile structure, but bacteria from the surrounding tissues or the urinary tract can cause an infection.

•Postoperative urinary tract infections (UTIs) are a particular concern and may require additional treatment with antibiotics.

 

3. Urinary Incontinence:

• Although the surgery aims to restore normal function, there is a risk of postoperative urinary incontinence if the surgery interferes with the normal sphincter function or if scarring occurs.

• Damage to the urethral sphincter during surgery may result in difficulties with controlling urination.

 

4. Recurrence of Prolapse:

• Brachycephalic breeds tend to have a higher surgical failure rate or recurrence of prolapse. The reason is unknown, but it is thought to be related to breathing issues associated with these breeds.

• There is a chance that the prolapse could recur, especially if the underlying cause of the prolapse (e.g., hormonal imbalances, trauma, or anatomical abnormalities) is not addressed.

• Recurrent prolapse may require further surgical interventions.

 

5. Urethral Stricture:

• Scar tissue formation during healing can lead to a narrowing (stricture) of the urethra, which may cause urinary obstruction or difficulty with urination.

• Strictures may require additional treatments, such as dilation or further surgery.

 

Hemorrhage (Bleeding):

• While the surgery itself typically involves minimal blood loss, there is always a risk of hemorrhage, particularly if there is inadvertent damage to nearby blood vessels during resection or suturing.

• Bleeding can be a concern postoperatively if blood vessels are not adequately controlled.

 

7. Urinary Obstruction:

• If the anastomosis (reconnection of the urethra) is not successful, or if there is excessive scarring or narrowing at the surgical site, urinary flow could be obstructed.

• This may lead to further difficulty urinating, bladder distension, or potential life-threatening conditions like urinary retention or rupture.

 

8. Dehiscence:

Dehiscence refers to the opening or breakdown of the surgical site. This can occur if the sutures do not hold, especially if there is increased tension at the site, excessive activity post-surgery, or infection.

 

9. Damage to Adjacent Structures:

The urethra is close to several important structures, including the bladder, rectum, and genitalia. There is a risk of unintentional injury to these structures during surgery, which could result in additional complications.

 

10. Postoperative Pain and Discomfort:

As with any surgery, there will be a period of postoperative pain and discomfort. This may require pain management (analgesics), and in some cases, behavioral changes due to pain or urinary urgency may be observed.