Case Series Presenting a Modified Approach for Permanent Perineal Urethrostomy in Horses

Abstract

Permanent perineal urethrostomy (PPU) may be performed in horses with severe preputial or penile trauma, in which surgical repair of extensive urethral damage is too complex or even impossible. We hypothesized that a modified PPU approach would abolish the use of postoperative indwelling urinary catheters (PIUC) and that the complication rate would be low. Therefore, the main objective of this report is to share our experience performing a modified approach for PPU in horses. Four geldings were referred after a history of severe urogenital laceration, and PPU was performed by removing a skin flap incision forming an inverted triangle (2.5 cm base and 5 cm sides) on the perineal raphe. None of the horses were submitted to the placement of PIUC. Short-term complications were restricted to partial PPU wound dehiscence in one horse, but this did not impede complete healing. Complications encountered after hospital discharge comprised urine staining of the hind legs in two (50%) horses. Urethral stoma retraction was a common sequel in all horses, but it did not impair urinary patency. The main limitations of this study were the small sample size and reliance on owner recall for outcome information. Overall, the complication rate was considered low, and owner satisfaction with the post-operative result was high. In conclusion, the modified approach for PPU using the inverted triangle-shaped incision adapted from the Williams technique of partial phallectomy proved to be a suitable alternative in the described horses, abolishing the use of PIUC. Furthermore, the urethral stoma remained patent in all horses even 75 months after surgery.

Keywords

• inverted triangle incision
• gelding
• urine staining
• urethral trauma
• urinary system
• williams technique